Advances in treatment of basal joint arthritis of the thumb

Abstract

Purpose of review Various forms of surgery have been successfully used to treat trapeziometacarpal osteoarthritis. However, no conclusive evidence is available to recommend one form of surgery over another. This is a review of recent surgical techniques and current concepts in the treatment of this common condition. Recent findings Early disease (stages 1 and 2) treated with ligament reconstruction or metacarpal extension osteotomy produces good results. Advanced disease (stages 3 and 4) continues to be treated successfully with trapezial excision, with or without additional soft-tissue procedures. Trapeziometacarpal joint replacement provides adequate pain relief, but loosening remains a concern. Satisfactory short-term results have been obtained using trapeziometacarpal arthroscopic procedures in stages 1 to 3 disease. Summary The initial management of basal joint arthritis should be nonsurgical. If this fails, surgery is recommended. Joint preserving procedures produce good outcomes in early disease. In advanced disease, some form of trapezial excision is required, and present evidence suggests that simple trapezial excision produces functional results equivalent to the more complex reconstructive procedures. Arthroscopy offers all the advantages of minimally invasive surgery, and early results are encouraging. There is a need for further comparative studies to determine if any procedure is superior to the others.