Comparative Analysis of Postoperative Outcomes at 6 Weeks and 6 Months: Basilar Thumb Reconstruction with Trapezium Excision and FiberLock InternalBrace Reconstruction with Tenodesis versus Thumb Trapeziectomy with Ligament Reconstruction and Tendon Interposition

Abstract

Background: Basilar Thumb Reconstruction (BTR) is a surgical procedure for the treatment of basilar thumb arthritis at the first carpometacarpal (CMC) joint of the thumb. There are a variety of surgical techniques that can be used in this procedure; however, they vary in post-operative outcomes of pain, function, recovery time, and strength. Optimizing surgical techniques in BTR is important for long-term patient outcomes, as the thumb is central for many activities of daily living. Research regarding the post-operative outcomes of BTR surgery with newer techniques, such as those with medical device implants, is crucial in determining the trajectory of this growing field. Hypothesis: FiberLock suture suspenionplasty will yield superior post-operative outcomes 6 weeks following BTR in terms of patient-reported outcome measures (PROMIS), functional disability (QuickDASH), and pain levels (painVAS) compared to trapexiectomy with ligament reconstruction and tendon interposition (LTRI) in patients with thumb CMC joint osteoarthritis. Methods: Retrospective data was collected on 77 patients with thumb carpometacarpal (CMC) arthritis who underwent trapeziectomy with LRTI or Arthrex FiberLockTM Suspension Implants (Arthrex, Naples, FL, USA) InternalBrace suspensionplasty with trapezium excision and side-to-side flexor carpi radialis tendon transfer. There were 39 LRTI and 39 FiberLock Internal Brace suspensionplasty procedures. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, and Patient-Reported Outcomes Measurement Information System (PROMIS) v1.2 Upper Extremity (UE) item bank. Patient demographic data was also recorded. Results: The PERMANOVA test revealed a significant difference in multivariate centroids between the groups (p < 0.01). Approximately 31.29% of the variation in the dataset was explained by the grouping variable. However, post-hoc pairwise tests demonstrated no significant (All p > 0.05) differences between groups for (VAS Pain 24 Hours, VAS Pain When Resting, VAS Pain When Active, PROMIS Upper Extremity, and Quick DASH). Summary Points: Our analysis demonstrated LRTI patient may have more consistent outcomes 6-weeks after surgery compared to the newer FiberLock procedure. However, it is promising that no significant differences were seen between the patient outcome surveys of the two groups. Future research on long-term outcomes will be beneficial in comparing the effects of this new surgical technique.