Basal joint arthroplasty: indications and treatment

Abstract

Arthritis of the basal joint of the thumb is common, affecting 25% of women and 8% of men between 50 and 70 years of age. The shallow concavity of the joint, ligament laxity, and relative thinness of the cartilage in women predisposes the trapeziometacarpal joint to high shear stresses and degeneration. Initial treatment remains nonoperative and includes rest, splints, nonsteroidal anti-inflammatory medication, steroid injection, and analgesics. Numerous surgical procedures have been developed that remove the arthritic joint surfaces and interpose soft tissue with or without stabilization of the joint by reconstruction of the anterior oblique ligament. Most techniques of basal joint arthroplasty result in pain relief, increased strength, stability of the reconstructed joint, and a high level of patient satisfaction. The choice of surgical procedure may be determined by the stage of disease, although some authors recommend trapeziectomy and ligament reconstruction for all cases of disease beyond Stage I.