What is Suture Suspension Arthroplasty for Thumb CMC Arthritis?
Suture suspension arthroplasty is a surgical procedure used to treat thumb carpometacarpal (CMC) joint arthritis, a common condition that causes pain, weakness, and reduced function in the hand.
The CMC joint is at the base of the thumb where the first metacarpal bone which extends into the palm articulates with a bone of the wrist called the trapezium. The suture suspension arthroplasty involves removal of the worn-out trapezium and a simple technique to stabilize the joint while preserving motion. It is a preferred alternative to traditional ligament reconstruction or total joint arthroplasty.
Indications for Suture Suspension Arthroplasty for Thumb CMC Arthritis
Suture suspension arthroplasty for thumb CMC arthritis is indicated for individuals with:
- Symptomatic osteoarthritis of the thumb CMC joint.
- Failure of conservative management, including splinting, medications, and corticosteroid injections.
- Pain and functional impairment affecting daily activities.
Procedure for Suture Suspension Arthroplasty
Suture suspension arthroplasty for thumb CMC arthritis is performed under regional anesthesia and involves the following procedure:
- Incision and Joint Exposure: A small incision is made over the first CMC joint, and the trapezium bone is completely excised.
- Suture Suspension Placement: Strong suture material is passed through the joint space from the base of the first metacarpal (thumb) at the insertion of the APL tendon and secured to the adjacent carpal bone (typically the second metacarpal (index finger) where the FCR tendon inserts. The suture is then passed again through the joint space a second time creating a suspensory mechanism that holds the thumb in position and allows range of motion.
- Soft Tissue Balancing: The surrounding soft tissues are adjusted to maintain stability and proper joint alignment.
- Closure and Immobilization: The wound is closed, and a splint or cast is applied for initial immobilization.
- The procedure typically takes around 25-30 minutes.
Benefits of Suture Suspension Arthroplasty
The advantages of suture suspension arthroplasty for thumb CMC arthritis include:
- Minimally Invasive Approach: Smaller incisions lead to reduced post-operative pain and faster recovery.
- Preserves Joint Function: Allows for greater mobility compared to traditional fusion techniques.
- Tissue Preservation: Tendons do not need to be sacrificed or transferred. Bone drilling is not required
- Reduced Risk of Complications: Eliminates the need for implants, such as suture anchors or pin fixation lowering the risk of foreign body reactions.
- Enhanced Stability: Provides sufficient support while allowing natural movement of the thumb.
Postoperative Care and Rehabilitation following Suture Suspension Arthroplasty
Postoperative care and rehabilitation following suture suspension arthroplasty involves:
- Immobilization: A splint is worn for 4-6 weeks to protect the surgical site.
- Physical Therapy: Gradual mobilization with hand therapy exercises helps restore strength and function.
- Pain Management: NSAIDs and analgesics are used to control post-operative discomfort.
- Activity Modification: Patients are advised to avoid excessive gripping or heavy lifting during early recovery.
Complications of Suture Suspension Arthroplasty for Thumb CMC Arthritis
Potential complications of suture suspension arthroplasty for thumb CMC arthritis include:
- Suture failure leading to instability.
- Persistent pain or stiffness.
- Tendon irritation or synovitis.
- Need for revision surgery in rare cases.