What’s in my Bag? CMC TightRope for Revisions or Advanced Disease with John Safanda, MD
Q: When do you use the TightRope?
A: I personally use the TightRope for all of my CMC arthroplasties. It is also a great option for advanced disease or in revision cases where tendon options may not be available.
Q: How many patients have you performed this procedure on? What are your results?
A: We began using the TightRope in 2009 and have performed the procedure on more than 150 patients. We recently completed the analysis of our first 100 patients. We were able to maintain metacarpal height in all patients irrespective of their preoperative arthritic stage. We also showed a statistically significant improvement in thumb abduction postoperatively.
Q: How has your surgical technique changed or evolved during the last five years?
A: The biggest change is that I quickly realized that I could place and secure the TightRope prior to excision of the trapezium. This allows us to precisely reconstruct the normal anatomy.
Q: What are the advantages of the TightRope in cases of advanced CMC arthritis?
A: The TightRope affords improved suspension as compared with traditional LRTI because the axis of suspension is placed higher on the index metacarpal. This allows us to better restore the thumb metacarpal height. This is particularly helpful in revision cases with proximal migration or in cases of advanced arthritis.
Q: Are there additional advantages?
A: Yes. By restoring the thumb metacarpal to its original height MP joint hyperextension is also improved. This has dramatically limited my need to perform stabilizing procedures or fusions at the MP joint.
Q: What is your post-op protocol in these cases?
A: Because of the immediate stability the TightRope provides, I am able to place both my straightforward and complex/revision cases into an accelerated post-op protocol. Patients are splinted for one week following surgery. At one week the post-op splint is removed and physical therapy is initiated. In addition to motion exercises, we allow the patient to begin pinch and grip strength training on the first day of therapy.
