Speaker: Sutures, implants may improve current treatments
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CHICAGO — New techniques and implants to treat carpometacarpal arthritis may soon take the place of ligament reconstruction with tendon interposition for this indication, providing better pinch strength and other benefits, a speaker said.
At the American Academy of Orthopaedic Surgeons Annual Meeting, Arnold-Peter C. Weiss, MD, FAAOS, said, a current trend is to use suture-based ligament reconstruction with tendon interposition (LRTI) instead of performing the procedure with soft tissue.
“A lot of people have gone to more suture suspension-type techniques and part of the reason for this is it’s easier to do. Suture doesn’t stretch. Tendon has a tensile stretch to it. So, there’s some inherent stretching when you put an LRTI in, even if you put it in tight,” he said.
In addition, FiberWire (Arthrex) suture can be used between the distal flexor carpi radialis and extensor pollicis longus in patients with carpometacarpal (CMC) arthritis, Weiss said, noting the morbidity of suture-based LRTI is low because graft harvest is unnecessary.
“It doesn’t require a cast or K-wires. These are stable in situ,” Weiss said.
Beyond improving upon the classic LRTI surgery that many hand surgeons learned to perform during their training, Weiss foresees implants being used in the CMC joint that are akin to total knee and hip replacement implants, an approach that has already been adopted in Europe.
“Whether you like the current operation or not, it’s interesting to note that in Europe the CMC implants are the majority of cases. They don’t do a lot of LRTIs. They either do an implant or they take the bone out and do nothing,” Weiss said during a forward-looking session at the meeting.
Soft tissue techniques for CMC joint arthritis have been associated with pinch weakness, which stems from an unstable fulcrum, and these beg for improvement, he said.
Studies from Europe show implants have a likelihood of better pinch strength. Today’s designs have come a long way from earlier designs that were linked with implant dislocation and loosening, Weiss said.
“I think you’re going to start seeing, over the next 5 to 10 years, implants start to come into the United States. So, these could be total joint-type implants, like total knee and total hip. They can have coatings on them; hydroxyapatite and other coatings that improve the bonding. They can be trapezium replacement types, whether it’s a rolled piece of collagen or a solid type of pseudo trapezium that you put in place, and hemiarthroplasty types, which do not take out the trapezium, and resurface the distal trapezial surface and provide some type of gliding surface,” he said.
When it comes to CMC treatments, patients and surgeons want shorter OR times, according to Weiss.
“You can do this in half the time. You get the same or better results. That’s pretty good – predictable outcomes, less pain, long-term survival and less therapy,” he said.
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Weiss A-PC. Flash five: What’s coming down the pike. Carpometacarpal arthritis. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 22-26, 2022; Chicago.
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