Efficiency of Surgical Technique in Thumb Carpometacarpal Joint Arthritis in the Veteran Population.

Abstract

Thumb arthritis is frequently seen in the veteran population. Surgical treatment depends on patient goals and functional demands, surgeon experience, and patient preference. This study compares operations to treat thumb arthritis in the veteran population: suspension arthroplasty with tightrope/internal brace, ligament reconstruction tendon interposition (LRTI), and Arthrex FiberLock suspensionplasty. A retrospective review was conducted on adult patients who presented to 4 hand surgeons at a single VA hospital with thumb arthritis over 12 years. Data included patient demographics, Eaton stage, and operation. Outcomes reviewed included postoperative thumb subsidence, range of motion, pain resolution, return to work/duty, need for reoperation, and operative time. Of 75 hand procedures, 69 met inclusion criteria. The average age was 63.6. The majority were male (54 M, 15 F) and right-handed. About 65% had left-sided procedures with Eaton stage 3 arthritis being most represented (57%), followed by Eaton stage 4 (33%). Suspension arthroplasty with tightrope/internal brace was performed on 40.6% of hands, LRTI on 47.8%, and Arthrex FiberLock suspensionplasty on 11.6%. There was no significant difference between operations for thumb subsidence, range of motion, or pain resolution. Operative time was significantly decreased with Arthrex FiberLock suspensionplasty. In the treatment of CMC arthritis in the veteran population, suspension arthroplasty, LRTI, and Arthrex Fiberlock have similar outcomes for all the studied outcomes, except operative time: Arthrex FiberLock suspensionplasty showed decreased operative time. Faster operative times can offer multiple clinically meaningful benefits, including lower complication risk, which prospective studies should assess.