gms | German Medical Science

Objectives/Interrogation: We introduce our results of treating CMC osteoarthritis by distal hemitrapecectomy and mini tight rope suspension system performed with a minimally invasive technique and no implant device.

Methods: From 2014 to 2017, 41 patients have been surgically treat by arthroscopic CMC arthroplasty.

Volar and dorsal CMC portals have been used, age ranges from 51 to 76 yo, 5 males and 36 females. Thumb traction was done in all cases, and no tissue or tendon interposition is done. All cases have type IV condral lesions in the trapezium an hemitrapecectomy was done by completely excised. When arthroscopic resection is completed under fluoroscope, a mini tight rope suspension system is implanted paying special attention that thumb abduction and retroversion range of motion must be complete. Clinical control is done with the Kaplan score, abduction and grip test; X-Ray controls are also done.

Three cases with severe MTC-P hyperextension were treated with sesamoid metacarpal fusion.

Results: Patients mean follow up is 2.2 years.

Pinch strength was restored between 100 to 80% compared to the contralateral hand at 4 months postop in 90% of cases, K10 in 87%. The mini tight rope had to be removed in 21% of cases because of disorders caused by metal plate or knot wire. Secondary surgery for trigger finger in the thumb happened in 12% of patients. No revision surgery was done neither to converse it into an arthroplasty or any other surgery on CMC.

X-Ray haven't revealed to be a useful tool to evaluate results. Incomplete edge trapezium resection or narrowing arthroplasty have the same functional results to those cases with more 3 mm gap between bases of metacarpal and trapezium resection.

Conclusion: A very attractive method for patients. Functional outcomes are satisfactory despite we consider it can only be performed by highly skilled surgeons and there still is a high rate of suspension system removes. X-Ray is not a useful technique to get prospective results.