Abstract
Complex regional pain syndrome (CRPS) type I may occur as complication after any type of surgery for basal joint arthritis of the thumb. We investigated prospectively in an ongoing study our results after a fully standardized treatment with a total joint prosthesis under vitamin C prophylaxis.Patients with trapeziometacarpal arthritis stage II or III according to Dell, and no benefit from conservative treatment, were selected to undergo joint replacement with a semi-constrained hydroxyapatite coated prosthesis.First web opening and visual analogue scale (VAS) scores for pain, activities of daily living (ADL) and satisfaction were taken pre and postoperatively. Vitamin C 500 mg daily was started two days prior to surgery during 50 days as prevention for CRPS. Post-operative treatment was functional.We performed 40 implantations for trapeziometacarpal arthritis in 34 patients (mean age 60.8 years; 27 females, 7 males) with a mean follow-up of 44 months. Operations were performed in day care under regional (or general) anesthesia.First web opening increased with 15.4 degrees and there was a significant improvement for pain, ADL and satisfaction as well (p = 0.000). Patient satisfaction was strongly associated with the amount of pain reduction. According to the Veldman and IASP criteria, there were no cases of CRPS.The overall complication rate for this procedure is high. Literature reports 5 cases of CRPS after 38 operations with the same implant (13%). We advise vitamin C as prophylaxis against CRPS in trapeziometacarpal joint replacement.
Highlights
Basal joint arthritis of the thumb is a common site for arthritis in the hand and the prevalence is highest in women [1]
Patients with trapeziometacarpal arthritis stage II or III according to Dell, and no benefit from conservative
There were 27 females and 7 males. In these 34 patients, there were 24 hands with stage III osteoarthritis according to Dell and 15 hands with stage II osteoarthritis according to Dell [2]
Summary
Basal joint arthritis of the thumb is a common site for arthritis in the hand and the prevalence is highest in women [1]. Different classifications have been described in the past [2,3]. The classification according to Dell combines radiological evaluation with clinical features and has our preference. Basal joint arthritis of the thumb is called arthritis of the carpometacarpal (CMC) joint of the thumb or first carpometacarpal joint (CMC I) or trapeziometacarpal (TM) osteoarthritis. Most patients with trapeziometacarpal arthritis are treated conservatively. These treatments differ in efficacy and may be applied as single treatment or in combination with each other. Conservative options are drug therapy, splinting or bracing, injection therapy and physical therapy. If these therapies fail, or if the process of degeneration and arthritis continues, surgical intervention might be a option
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