Purpose

Various arthroplasty procedures have been described for the treatment of thumb carpometacarpal joint (CMC) osteoarthritis. The purpose of this study is to determine the outcomes of patients treated with trapeziectomy and a variation of abductor pollicis longus (APL) suspension arthroplasty.

Methods

18 consecutive patients with osteoarthritis of the thumb CMC joint were treated by a single surgeon with trapeziectomy and APL suspension arthroplasty (21 thumbs). The radial slip of the APL was used for the reconstruction. Prospective outcomes data were collected before the operation, and at 3, 6 and 12 months after surgery. Outcomes were assessed with x-rays, grip/key pinch strength, the Jebsen-Taylor test and the Michigan Hand Outcomes Questionnaire (MHQ). Tourniquet time was recorded as well. These results were compared to our retrospective series of 35 flexor carpi radialis (FCR) ligament reconstructive procedures and to the literature.

Results

Immediately after surgery, a 32% loss in CMC height was observed and an additional 11% proximal metacarpal migration was observed at 1 year. The mean grip strength was 11.1 kg pre-operatively, and 7.7 kg, 14.3 kg, and 16.7 kg at 3 months, 6 months and 1 year post-operatively. These results were comparable to published series. The Jebsen-Taylor scores showed a improvement from 47 seconds pre-operatively to 40 seconds at 3 months, 34 seconds at 6 months (p=0.03), and 33 seconds at 1 year (p=0.01). The MHQ results demonstrated improvements in all domains. Statistically significant improvements were noted in the domains of overall score from 41 to 67 (p=0.03), activities of daily living from 43 to 66 (p=0.01), work from 41 to 65 (p=0.05), patient satisfaction from 25 to 68 (p=0.01), and pain decreased from 73 to 30 (p<0.01). The mean tourniquet time for the trapeziectomy with APL suspension arthroplasty was 33 minutes, while the mean tourniquet time for trapeziectomy with FCR ligament reconstruction and tendon interposition was 42 minutes (p=0.02).

Conclusion

Abductor pollicis longus suspension arthroplasty is a faster and technically easier technique that avoids any additional deficit by using an accessory tendon. Its outcomes are comparable to those in our retrospective FCR series and to published data in the literature. Furthermore, APL suspension arthroplasty gives acceptable patient-rated outcomes especially in pain relief and satisfaction.