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What is CMC Arthroplasty with TightRope?

CMC arthroplasty with TightRope, also known as carpometacarpal suspensionplasty, is a novel procedure employed for the treatment of basal joint arthritis (thumb arthritis) found within the trapezium bone of the carpometacarpal (CMC) joint. It addresses the associated narrowing of the joint space, instability, and dislocation. The procedure involves trapezial resection to remove the diseased joint tissue and repair of the first and second metacarpal using a suspensory device or TightRope to maintain proper thumb functioning.

Basal joint arthritis is also referred to as CMC joint arthritis of the thumb.

What is CMC Arthritis of the Thumb?

The carpometacarpal joint attaches the base of the thumb to the wrist. It is formed from two bones, the metacarpal and trapezium, and affects how strongly the hand can grasp objects. People with osteoarthritis of the thumb can experience severe pain, swelling, and decreased motion at this joint, finding it extremely difficult to perform everyday activities such as opening and closing the lid of a jar or turning a doorknob.

Arthritis of the thumb causes degeneration of the cartilage between the two joint bones, the trapezium and the metacarpal. In a normal basal joint, cartilage covers the ends of the bones, acting as a cushion and allowing bones to glide smoothly against each other. With thumb arthritis, the cartilage that covers the ends of the bones deteriorates and its smooth surface roughens. The bones then rub against each other, resulting in friction, and joint damage.

Indications for CMC Arthroplasty with TightRope

The first and most common indication for CMC arthroplasty with TightRope is pain and discomfort at the base of your thumb during activities such as gripping, grasping or pinching. Other indications that necessitate CMC arthroplasty with TightRope include:

  • Tenderness, stiffness, and swelling at the base of the thumb
  • Pain that gets worse after prolonged use of the thumb
  • Enlarged and bony ("out-of-joint") appearance at the base of the thumb
  • Limited motion of the thumb and feeling of loss of strength
  • Grinding sensation with a grating sound when moving the thumb
  • Failed conservative treatment options to provide relief

Preparation for CMC Arthroplasty with TightRope

In general, preoperative preparation for CMC arthroplasty with TightRope will involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo blood and imaging tests to screen for abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from taking anti-inflammatories or blood-thinning medications such as aspirin at least a week prior to surgery.
  • You should refrain from alcohol or tobacco at least a week before surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for CMC Arthroplasty with TightRope

In general, CMC arthroplasty surgery with TightRope will involve the following steps:

  • You will lie on your back on the operating table under regional or local anesthesia with your arm held in a specific position.
  • Your surgeon cleans the treatment area with an antiseptic solution and an incision is made in the wrist near the CMC joint.
  • The underlying muscles are carefully separated to expose the diseased CMC joint.
  • Your surgeon will remove a part or all of the trapezium bone (trapeziectomy) and the remaining surfaces of the CMC joint are smoothed, along with other damaged joint surfaces.
  • Your surgeon then suspends the first metacarpal to the second by using strong suture material (FiberWire) passed through the metaphyses of both bones and fixed with two oblong stainless steel suture buttons for cortical fixation.
  • The TightRope technique aids and maintains the index and thumb metacarpals in their proper position with respect to each other, while enabling healing and scar tissue development in the trapezial space.
  • Your surgeon may also carry out other repairs as necessary.
  • The overlying soft tissue and skin are closed with sutures, and sterile bandages are applied.
  • A splint or a cast is placed on the treatment area in order to protect the repair and facilitate healing.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after CMC arthroplasty with TightRope will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • You may notice some pain, swelling, and discomfort in the thumb area. Pain and anti-inflammatory medications are provided as needed.
  • Antibiotics are also prescribed to address the risk of surgery-related infection.
  • You are advised to wear the splint or thumb cast for at least six weeks.
  • You will need to keep your hand elevated at all times during the first month. Your physician may recommend a foam wrist-elevation pillow or other devices.
  • You may start rehabilitation or a physiotherapy regimen as recommended by your surgeon after a specified period of time to improve range of motion and strengthen hand muscles.
  • Keep the surgical site clean and dry. Instructions on surgical site care, splint/cast management, and bathing will be provided.
  • By the beginning of the third month, you will be weaned off the splint and can gradually return to normal daily activities.
  • You will be able to use the treated arm 6 weeks after surgery. However, it may take 6 to 12 months for your arm to regain its full strength.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

CMC arthroplasty with TightRope is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Numbness
  • Chronic pain
  • Swelling
  • Stiffness
  • Tingling or prickling sensation
  • The need for repeat surgery
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