Surgical treatment of arthritis of the thumb saddle joint

Abstract

Surgical treatment of rhizarthrosis is indicated in progression of the symptoms and increase of functional restriction despite conservative treatment. The etiopathogenesis of genuine arthrosis has not yet been clarified completely. Recent investigations show the great importance of the first intercarpal ligament for the stability of the basal joint of the thumb and its important role in the development of arthrosis. Several surgical measures are available to us and require differentiated establishment of the indication. First of all, there is trapezektomy with and without tendon interposition; this enables an improvement of symptoms. However, the increasing shortening of the thumb and the weakness and limitation to movement associated with this is to be regarded as disadvantageous. A surgical technique for restoration of the ligament connection between the first and the second metacarpalia after extirpation of the trapezium is presented. The results of this method are compared with those of the conventional technique. In all 12 of a total of 20 hands operated on in this way, the proximal displacement of the first metacarpum could be largely prevented. The remaining clinical parameters are also convincing.