Comparative analysis of surgical outcomes of arthrodesis and suspension arthroplasty of the saddle joint

Introduction Trapeziometacarpal osteoarthritis is a very common condition that leads to progressive loss of  functionality of the first finger that can be surgically treated with arthrodesis of the saddle joint and suspension arthroplasty of the first metacarpal bone. There is a controversy over the surgical technique to choose without consensus in the literature.

The objective was to compare surgical outcomes of patients with trapeziometacarpal osteoarthritis treated with arthrodesis and suspension arthroplasty of the saddle joint.

Material and methods The use of both surgical options resulted in significantly reduced pain measured with  the  VAS (p < 0.001) and improved upper limb function evaluated with the Quick DASH scale. The  treatments differed in the median duration of plaster immobilization. The duration of postoperative immobilization in arthrodesis patients was statistically higher (p = 0.004) than that in suspension arthroplasty group. No statistically significant differences were found between the two groups of heavy and light manual laborers (Pearson coefficient = 0.311).

Discussion The findings of the series indicated parameters being different from those published in  the  literature. The dependence between functional results and the type of working activity of patients treated with both surgical methods was not confirmed. The choice between trapezio-metacarpal arthrodesis and  suspension arthroplasty of the first metacarpal bone based on the criterion of severity of work was not always correct. Increased periods of plaster immobilization in the saddle arthrodesis group are reported in the literature and associated with complications of the treatment option.

Conclusion No significant differences were found between the outcomes of saddle arthrodesis and suspension arthroplasty of the first metacarpal bone.

1. Kalichman L, Hernández-Molina G. Hand osteoarthritis: an epidemiological perspective. Semin Arthritis Rheum. 2010;39(6):465-476. doi: 10.1016/j.semarthrit.2009.03.001.

2. Matullo KS, Ilyas A, Thoder JJ. CMC arthroplasty of the thumb: a review. Hand (N Y). 2007;2(4):232-239. doi: 10.1007/s11552-007-9068-9.

3. Athlani L, Bergere M, Motte D, Prandi B, Beaulieu JY, Moissenet F. Trapeziometacarpal joint loading during key pinch grip: A cadaver study. Hand Surg Rehabil. 2022;41(2):204-209. doi: 10.1016/j.hansur.2021.11.009.

4. van der Oest MJW, Duraku LS, Andrinopoulou ER, et al. The prevalence of radiographic thumb base osteoarthritis: a meta-analysis. Osteoarthritis Cartilage. 2021;29(6):785-792. doi: 10.1016/j.joca.2021.03.004.

5. Sonne-Holm S, Jacobsen S. Osteoarthritis of the first carpometacarpal joint: a study of radiology and clinical epidemiology. Results from the Copenhagen Osteoarthritis Study. Osteoarthritis Cartilage. 2006;14(5):496-500. doi: 10.1016/j.joca.2005.12.001.

6. Batra S, Kanvinde R. Osteoarthritis of the thumb trapeziometacarpal joint. Curr Orthop. 2007;21(2):135-144. doi: 10.1016/j.cuor.2007.02.006.

7. Hautefeuille P, Duquesnoy B. Root arthrosis of the thumb. Rev Prat. 1991;41(26):2714-2717.

8. Kennedy CD, Manske MC, Huang JI. Classifications in Brief: The Eaton-Littler Classification of Thumb Carpometacarpal Joint Arthrosis. Clin Orthop Relat Res. 2016;474(12):2729-2733. doi: 10.1007/s11999-016-4864-6.

9. Heyworth BE, Lee JH, Kim PD, et al. Hylan versus corticosteroid versus placebo for treatment of basal joint arthritis: a prospective, randomized, double-blinded clinical trial. J Hand Surg Am. 2008;33(1):40-48. doi: 10.1016/j.jhsa.2007.10.009.

10. Comtet JJ, Rumelhart C. Total trapezometacarpal prostheses: concepts and classification study. Chir Main. 2001;20(1):48-54. (In French) doi: 10.1016/s1297-3203(01)00013-0.

11. Mureau MA, Rademaker RP, Verhaar JA, Hovius SE. Tendon interposition arthroplasty versus arthrodesis for the treatment of trapeziometacarpal arthritis: a retrospective comparative follow-up study. J Hand Surg Am. 2001;26(5):869-876. doi: 10.1053/jhsu.2001.26659.

12. Barbier O, Chryssagi AM, Hugon S, et al. Prospective functional analysis of trapeziectomy combined with intermetacarpal tendon stabilisation in trapeziometacarpal arthritis. Acta Orthop Belg. 2004;70(5):410-416.

13. Schröder J, Kerkhoffs GM, Voerman HJ, Marti RK. Surgical treatment of basal joint disease of the thumb: comparison between resection-interposition arthroplasty and trapezio-metacarpal arthrodesis. Arch Orthop Trauma Surg. 2002;122(1):35-38. doi: 10.1007/s004020100313.

14. Weilby A. Tendon interposition arthroplasty of the first carpo-metacarpal joint. J Hand Surg Br. 1988;13(4):421-425. doi: 10.1016/0266-7681_88_90171-4.

15. DelSignore JL, Zambito K, Ballatori SE. Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: 12- to 14-Year Follow-up. Hand (N Y). 2023;18(1):105-112. doi: 10.1177/15589447211003176.

16. Kazmers NH, Hippensteel KJ, Calfee RP, et al. Locking Plate Arthrodesis Compares Favorably with LRTI for Thumb Trapeziometacarpal Arthrosis: Early Outcomes from a Longitudinal Cohort Study. HSS J. 2017;13(1):54-60. doi: 10.1007/s11420-016-9527-3.

17. Spekreijse KR, Selles RW, Kedilioglu MA, et al. Trapeziometacarpal Arthrodesis or Trapeziectomy with Ligament Reconstruction in Primary Trapeziometacarpal Osteoarthritis: A 5-Year Follow-Up. J Hand Surg Am. 2016;41(9):910-916. doi: 10.1016/j.jhsa.2016.07.089.

18. Barakat MJ, Field J, Taylor J. The range of movement of the thumb. Hand (N Y). 2013;8(2):179-182. doi: 10.1007/s11552-013-9492-y.

19. Bettinger PC, Linscheid RL, Berger RA, et al. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg Am. 1999;24(4):786-798. doi: 10.1053/jhsu.1999.0786.

20. Save AV, Wolfe SW, Victoria C, Osei DA. Trapeziometacarpal Joint Arthrodesis Using a Cannulated Compression Screw and Locking Plate Construct. HSS J. 2022;18(4):559-565. doi: 10.1177/15563316221088579.

21. Smeraglia F, Soldati A, Orabona G, et al. Trapeziometacarpal arthrodesis: is bone union necessary for a good outcome? J Hand Surg Eur Vol. 2015;40(4):356-361. doi: 10.1177/1753193414564095.

22. Forseth MJ, Stern PJ. Complications of trapeziometacarpal arthrodesis using plate and screw fixation. J Hand Surg Am. 2003;28(2):342 345. doi: 10.1053/jhsu.2003.50042.

23. Guzzini M, Perugia D, Proietti L, et al. Suspension arthroplasty versus interposition arthroplasty in the treatment of trapeziometacarpal osteoarthritis: a clinical and magnetic resonance imaging study. Int Orthop. 2019;43(3):647-651. doi: 10.1007/s00264-019-04292-3.

24. Saheb RLC, Vaz BAS, Soeira TP, et al. Surgical treatment for rhizarthrosis: a systematic review of the last 10 years. Acta Ortop Bras. 2022;30 (1):e246704. doi: 10.1590/1413-785220223001e246704.

25. Esenwein P, Hoigne D, Zdravkovic V, Sanchez T. Resection, interposition and suspension arthroplasty for treatment of Basal joint arthritis of the thumb: a randomized and prospective comparison of techniques using the abductor pollicis longus- and the flexor carpi radialis tendon. Handchir Mikrochir Plast Chir. 2011;43(5):289-294. (In German) doi: 10.1055/s-0031-1285883.

26. Pillukat T, Mühldorfer-Fodor M, Fuhrmann R, et al. Arthrodesis of the trapeziometacarpal joint. Oper Orthop Traumatol. 2017;29(5):395 408. In German) doi: 10.1007/s00064-017-0515-7.

27. Родоманова Л.А., Орлова И.В. Хирургическое лечение остеоартроза седловидного сустава (обзор литературы). Травматология и ортопедия России. 2018:24(3):135-144. doi: 10.21823/2311-2905-2018-24-3-135-144.

28. Satria O, Wibowo RS, Putra GU, Fathurrahman I. Suture suspension sling arthroplasty in thumb carpometacarpal joint arthritis: A case series. Int J Surg Case Rep. 2023;110:108583. doi: 10.1016/j.ijscr.2023.108583.

29. Tosun SC, Pietzsch LB, Held M, et al. Rhizarthrosis: Resection Arthroplasty versus Resection Suspension Arthroplasty - Still the Gold Standard? Handchir Mikrochir Plast Chir. 2024;56(3):219-226. (In German) doi: 10.1055/a-2231-2279.

30. Егиазарян К.А., Парсаданян Г.К., Ершов Д.С. и др. Среднесрочные результаты хирургического лечения ризартроза методами интерпозиционной и суспензионно-интерпозиционной артропластики. Травматология и ортопедия России. 2023;29(4):69 77. doi: 10.17816/2311-2905-17288.