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Trapezium Excision and Suture Suspensionplasty (TESS) for the Treatment of Thumb Carpometacarpal Arthritis

Putnam, Matthew D. MD; Meyer, Nicholas J. MD; Baker, Daniel MD; Brehmer, Jess MD; Carlson, Brent D. MD

Techniques in Hand & Upper Extremity Surgery: June 2014 - Volume 18 - Issue 2 - p 102–108
doi: 10.1097/BTH.0000000000000046

Basilar thumb arthritis, or first carpometacarpal arthritis, is a common condition affecting older women and some men. It is estimated that as many as one third of postmenopausal woman are affected. Surgical treatment of this condition includes options ranging from arthrodesis to prosthetic arthroplasty. Intermediate options include complete or partial trapezial excision with or without interposition of a cushioning/stabilizing material (auto source, allo source, synthetic source). A multitude of methods appear to offer similar end results, although some methods definitely involve more surgical work and perhaps greater patient risk. Through retrospective evaluation of a cohort of patients who underwent suture suspensionplasty, we determined the postoperative effect on strength, motion, patient satisfaction, complications, and radiographic maintenance of the scaphoid-metacarpal distance. This review shows the method to be clinically effective and, by comparison with a more traditional ligament reconstruction trapezial interposition arthroplasty, the method does not require use of autograft or allograft tendon and has fewer surgical steps. Forty-four patients were included in this retrospective study. The results showed that 91% of patients were satisfied with the procedure. Pinch and grip strength remained the same preoperatively and postoperatively. A Disabilities of the Arm, Shoulder, and Hand patient-reported outcome instrument (DASH) scores averaged 30 at final follow-up. Three patients developed a late complication requiring further surgical intervention. In summary, this technique appears to be technically reproducible, requires no additional tendon material, and achieves objectively and subjectively similar results to other reported procedures used to manage first CMC Arthritis.

*Department of Orthpaedic Surgery, University of Minnesota, Minneapolis

St. Croix Orthopaedics, Stillwater

§Northern Pines Orthopaedics, Grand Rapids

Department of Orthopaedic Surgery, Mayo Clinic Health System—Red Wing, Red Wing, MN

Chippewa Falls Orthopedics & Sports Medicine, Chippewa Falls, WI

This study was approved by the IRB at the University of Minnesota (0303E45001)

Portions of this work were previously presented as a podium presentation at the AAOS Annual Meeting (2006).

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Matthew D. Putnam, MD, Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Av., Ste. R200, Minneapolis, MN 55454. E-mail:

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