Trapezium resection with suspension and interposition arthroplasty using acellular dermal allograft for thumb carpometacarpal arthritis.

Abstract

PURPOSE:

Trapezium excision with ligament reconstruction and tendon interposition has proved to be highly effective in the treatment of thumb carpometacarpal joint arthritis. Donor-site morbidity from autograft harvest can be avoided by using an allograft. We report the outcomes after suspension and interposition arthroplasty using an acellular dermal allograft (GraftJacket; Wright Medical Technology, Inc., Arlington, TN) for thumb carpometacarpal arthritis.

METHODS:

Eighty-nine patients (100 thumbs) had surgery for thumb carpometacarpal arthritis using acellular dermal allograft instead of flexor carpi radialis tendon autograft. Evaluation of the results was performed for 82 thumbs with adequate data. Each patient was followed up for a minimum of 12 months (average, 30 months). Pain levels, grip strength, key pinch strength, range of motion, and radiographic measurements were performed.

RESULTS:

Between the preoperative and final follow-up measurements, patient pain levels (on a visual analog scale) were significantly reduced, from 6.2 to 0.7. Comparisons between preoperative and postoperative strength measurements showed an average 16% increase in grip strength and 19% increase in key pinch strength. No differences were found for radial abduction and palmar abduction data, respectively. Comparison with the preoperative x-rays showed the thumb metacarpal had subsided 31% of the arthroplasty space. No patient experienced a foreign body reaction or suffered an infection in our series.

CONCLUSIONS:

Trapeziectomy with suspension and interposition arthroplasty using an acellular dermal allograft is highly effective for the treatment of thumb carpometacarpal arthritis. This procedure provides a safe and effective alternative to autograft for both ligament reconstruction and tendon interposition and eliminates the potential morbidity of autograft harvest.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Therapeutic IV.

• Authors: Zinon T Kokkalis, George Zanaros, Robert W Weiser, Dean G Sotereanos
• Journal: The Journal of hand surgery (J Hand Surg Am) 2009 Jul-Aug Vol. 34 Issue 6 Pg. 1029-36 ISSN: 1531-6564 [Electronic] United States
• PMID: 19500916 (Publication Type: Journal Article)

Chemical References

• Alloderm
• Biocompatible Materials
• Collagen

Topics

• Adult
• Aged
• Arthroplasty (methods)
• Biocompatible Materials (therapeutic use)
• Carpometacarpal Joints (surgery)
• Collagen (therapeutic use)
• Female
• Humans
• Ligaments, Articular (surgery)
• Male
• Middle Aged
• Osteoarthritis (surgery)
• Pain Measurement
• Thumb
• Transplantation, Homologous
• Trapezium Bone (surgery)