Thumb Basal Arthritis Research Articles

Basal thumb arthritis surgery: complications and its management.

The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.

Regenerative Therapies for Basal Thumb Arthritis-A Systematic Review.

Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local steroid injections and/or surgery. Yet, therapeutic data on long-term improvement and even cartilage repair are scarce. This review aims to present the currently available literature on novel therapies for basal thumb arthritis, including platelet-rich plasma (PRP), fat grafting and phototherapy, and investigate their potential efficacy. The entire OVID database and PubMed were searched for studies containing the topics PRP injection, lipofilling, laser treatment and regenerative treatment for carpometacarpal arthritis. Seven studies on the effect of fat tissue on basal thumb arthritis were found. Four authors reported on PRP injections, one RCT examined a combinational treatment of PRP and fat grafting, another phototherapy for the thumb joint and one prospective trial on chondrocyte transplantation was found. Pain improvement and decreased impairment were reported in the majority of PRP and/or fat grafting studies as well as after chondrocyte implantation. Phototherapy did not significantly improve the condition. This review revealed that only limited data on regenerative therapies for carpometacarpal arthritis are currently available, yet PRP and lipofilling show promising results and merit further investigation.

Precision of the Wilson corrective osteotomy of the first metacarpal base using specific planning and instruments for treatment of basal thumb arthritis

IntroductionArthritis of the basal thumb is a relatively common condition also affecting younger patients. Wilson et al. described a 20°–30° closing wedge osteotomy of the first metacarpal bone to unload the trapeziometacarpal joint. It was the purpose of this study to analyze the clinical and radiographic outcome of patients who underwent proximal extension osteotomy of the first metacarpal bone using patient-specific planning and instruments (PSI).MethodsAll patients who underwent proximal metacarpal osteotomy for basal thumb arthritis at our tertiary referral center were retrospectively included. The patients underwent preoperative planning using computed tomography and 3D segmentation to build patient-specific guides and instruments for the operative treatment. Stable fixation of the osteotomy was achieved by internal plating. The inclusion criterion was a minimum follow-up of 1 year with clinical examination, including the Michigan Hand Outcomes Questionnaire (MHQ), and computed tomography to validate the correction. Complications and reinterventions were recorded.ResultsA total of eight Wilson osteotomies in six patients could be included at a mean follow-up duration of 33±16 months (range, 12 to 55 months). The patients were 49±8 years (range, 36 to 58 years) at the surgery and 88% were female. The postoperative MHQ for general hand function was 77±8 (range, 45 to 100) and the MHQ for satisfaction was 77±28 (range, 17 to 100). The working status was unchanged in 7/8 hands (6/7 patients). Radiographic analysis revealed successful correction in all cases with unchanged Eaton–Littler stage in 7/8 hands. No complications were recorded.ConclusionThe combined extending and ulnar adducting osteotomy using patient-specific guides and instrumentation provides an accurate treatment for early-stage thumb arthritis.Level of evidenceType IV—retrospective, therapeutic study.

Carpometacarpal Ligament Reconstruction, Surgical Technique and Outcomes.

Basal thumb arthritis is a common condition with the earliest stage described as a period of ligament laxity and joint instability, without radiographic signs of arthritis. The condition is usually managed conservatively but a number of individuals can present with persistence of symptoms. We would like to describe our preferred technique for the management carpometacarpal ligament instability and laxity. This technique utilizes a slip of the flexor carpi radialis tendon and offers reconstruction of the intermetacarpal, dorsoradial and anterior oblique ligaments in an anatomic fashion using standard instruments available. The author has performed this technique in 33 patients over a course of 10 years and long-term outcomes of these cases are presented in this paper.

Ligament Reconstruction and Tendon Interposition Using Flexor Carpi Radialis Tendon for the Treatment of Basilar Thumb Arthritis: A Case Report

Introduction: Basilar thumb arthritis is most common arthritis affected about 10% of middle aged women and one third of postmenopausal women had this condition. The disease is often not shown significant symptom, when become a symptomatic can provide 50% loss of function. Conservative treatment with mild arthtritis usually had a good respond. Surgery is indicated in patients who failed to conservative treatment. Ligament reconstruction and tendon interposition is the surgical approach commonly used to treat basal joint arthtritis. Case Presentation: A 61-year-old woman complained swelling and also pain at the base of the left thumb more than 1 year and unable to do a daily activity and getting worse, also complained weakness grip. Plain radiograph of hand showed the trapezial space height about 10mm and diagnosed with basilar thumb arthritis of the left hand Eaton stage III with DASH score pre operatively is 60.8. The patient done with LRTI procedure and used thumb spica cast for immobilized 4 weeks. The DASH Score Post operatively is 40.7 and after 6 months the score is improve to 19.2. Conclusion: Basal Thumb Arthritis is a common condition affecting postmenopausal women with a deformity consisting of a MCP hyperextension deformity accompanied by swelling, tenderness and crepitus. Eaton Classification used to staging of basal thumb arthritis and help to decide the treatment. LRTI is one approach to treat patients with CMC arthritis who has a high level of satisfaction and objectivity in measuring function, including restoring of the strength and ability of the affected thumb. Keywords: Basilar, Thumb, Joint, Arthritis, Ligament reconstruction, tendon interposition.

Assessment of modified Zancolli arthroplasty for basal thumb arthritis

Background and aim The trapeziometacarpal arthritis is one of the most common joint problems affecting women after the age of 50 years. Surgery is indicated after failure of conservative treatment with continuation of pain and functional disabilities. One of the most reported and well-known surgical procedure for management of basal thumb arthritis is the ligament reconstruction and tendon interposition arthroplasty. The aim of the study was to evaluate patients who underwent modified Zancolli arthroplasty for basal thumb arthritis. Patients and methods The study included 15 patients with basal thumb arthritis (three males and 12 females). Full clinical examination and scoring of the hand was done using Quick DASH, visual analog scale, measuring range of motion, and grip strength. All patients underwent full radiological and laboratory investigations. Results Overall pain intensity was measured with a visual analog scale, which ranged from 5–10 preoperatively and ranged from 0 to 1 6 months postoperatively. Regarding the DASH score, there was improvement from a mean of 64.48±16.61 points preoperatively to a mean of 1.37±1.67 points postoperatively. The mean postoperative abduction was 75% to the normal side, opposition was 80% to the normal side, and power grip was 90% to the normal hand. Conclusion Modified Zancolli arthroplasty is an effective means of treating symptomatic patients with trapeziometacarpal arthritis who failed to improve with nonsurgical measures. This technique ensures a dynamic fixation of the apical ligament and provides better stability. The procedure is simple both technically and regarding postoperative care.

Anatomy and biomechanics of healthy and arthritic trapeziometacarpal joints

Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints.

Cost Analysis and National Trends in the Treatment of Thumb Basal Arthritis: Comparing Ligament Reconstruction/Tendon Interposition and Trapeziectomy/Hematoma Distraction Arthroplasty.

Thumb basal arthritis (TBA) is a common form of arthritis characterized by wearing away of cartilage in the crarpometacarpal joint at the base of the thumb. The purpose of the study was to analyze cost trends of the 2 common surgical treatments options: ligament reconstruction/tendon interposition (LRTI) and trapeziectomy/hematoma distraction arthroplasty (THDA). The Vizient Clinical Data/Resource Manager electronic database was reviewed for the 3 treatment procedures of TBA from January 1, 2016, to December 31, 2019. Cases were placed into 1 of 2 categories: LRTI or THDA. Total and direct costs were averaged and compared nationally and regionally. One-tailed t test and Pearson correlation analyses were performed (P < 0.05 and r > 0.9 or r < -0.9 was considered significant). A total of 28,887 total cases (26,405 LRTI, 2482 THDA) were analyzed. There was a 49% increase in number of surgical procedures to treat TBA between 2015 and 2018. Ligament reconstruction/tendon interposition (91%) had larger market share than THDA (9%). However, market share percentage of each procedure stayed the same over time. Trapeziectomy/hematoma distraction arthroplasty had lower average cost (US $4157) compared with that of LRTI (US $4446, P = 0.06) However, THDA had a significant positive trend in cost, increasing 14% in 4 years. In 2019, 30% of procedures performed were in the Midwestern United States, 27% Northeastern United States, 24% Southern United States, and 19% Western United States. Most patients with TBA seem to be treated with LRTI. The market share seems to be greatest for LRTI and lowest for THDA nationally and regionally. Although the average cost for THDA was less than that of LRTI, this difference was not significant.

Pyrocarbon implants for the basal thumb arthritis

Silicone implants for the treatment of basal thumb arthritis were first proposed in the 1970’s by Swanson. They became extremely popular and despite good functional results, the high rate of complications such as instability, material breakage and foreign body reactions led to them being progressively abandoned by most surgeons. Pyrocarbon implants were introduced at the beginning of the 2000’s. A large range of different implant models that can be used for either hemiarthroplasty or interposition arthroplasty. For some implants, a supplemental ligamentoplasty procedure is required to avoid instability. Miniaturization of some implants provides new options for minimally invasive surgery, which is relevant in low and medium grades of osteoarthritis, especially for young, active patients. Medium- and long-term follow-up have now been reached by some pyrocarbon interpositions. Their results confirm that these implants are a reliable alternative to other techniques. This paper focuses on the surgical techniques and outcomes of pyrocarbon implants for the treatment of basal thumb arthritis. It is based on published data and the author’s experience.

Manual ability in hand surgery patients: Validation of the ABILHAND scale in four diagnostic groups.

BackgroundPatients treated in hand surgery (HS) belong to different demographic groups and have varying impairments related to different pathologies. HS outcomes are measured to assess treatment results, complication risks and intervention reliability. A one-dimensional and linear measure would allow for unbiased comparisons of manual ability between patients and different treatment effects.ObjectiveTo adapt the ABILHAND questionnaire through Rasch analysis for specific use in HS patients and to examine its validity.MethodsA preliminary 90-item questionnaire was presented to 216 patients representing the diagnoses most frequently encountered in HS, including distal radius fracture (n = 74), basal thumb arthritis (n = 66), carpal tunnel syndrome (n = 53), and heavy wrist surgery (n = 23). Patients were assessed during the early recovery and in the late follow-up period (0–3 months, 3–6 months and >6 months), leading to a total of 305 assessments. They rated their perceived difficulty with queried activities as impossible, difficult, or easy. Responses were analyzed using the RUMM2030 software. Items were refined based on item-patient targeting, fit statistics, differential item functioning, local independence and item redundancy. Patients also completed the QuickDASH, 12-item Short Form Survey (SF-12) and a numerical pain scale.ResultsThe rating scale Rasch model was used to select 23 mostly bimanual items on a 3-level scale, which constitute a unidimensional, linear measure of manual ability with good reliability across all included diagnostic groups (Person-Separation Index = 0.90). The resulting scale was found to be invariant across demographic and clinical subgroups and over time. ABILHAND-HS patient measures correlated significantly (p<0.001) with the QuickDASH (r = -0.77), SF-12 Physical Component Summary (r = 0.56), SF-12 Mental Component Summary (r = 0.31), and pain scale (r = -0.49).ConclusionABILHAND-HS is a robust person-centered measure of manual ability in HS patients.

Basal thumb arthritis: Treatment strategies for managing pain.

The carpometacarpal joint of the thumb is one of the joints most commonly affected by arthritis. The dominant hand is involved in 60-65% of cases, with a higher prevalence among women. The condition results in significant disability of the hand, which affects activities of daily living. Management is dependent on both the clinical stage of the disease and patient expectations and demands. The aim of this article is to review the current non-operative and operative modalities in managing pain symptoms, and explore evidence for the use of these modalities. Basal thumb arthritis is a very common condition encountered by the general practitioner. Treatment must focus on functional expectations and demands of the patient, and individualised treatment plans need to be tailored to the patient. Hand therapy in addition to patient education and use of an orthosis has been shown to be very effective in management of the early stages of basal thumb arthritis. With more advanced disease, surgical modalities provide better symptomatic control.

Revision surgery after resection arthroplasty of the thumb saddle joint

Resection arthroplasty still is the gold standard for the treatment of basal thumb arthritis. In most patients, satisfactory results can be expected. However, the few patients with persisting problems are achallenge for the hand surgeon. They may complain of neuromas, tendinitis of the flexor carpi radialis (FCR) tendon, impingement and/or proximalization of the first metacarpal, arthritis of the scaphotrapezoidal joint or carpal collapse in the case of pre-existing scapholunate instability. This includes subtle clinical examination. Radiography may be completed by a CT scan. Probational infiltration is ahelpful tool to confirm diagnosis and may be the first step of aconservative treatment, when supplemented by orthoses. Revision surgery is guided by the nature of the present problem. Neurolysis should be indicated cautiously and performed according to existing principles. FCR tendinitis is treated by release or resection of the tendon. Impingement of the first metacarpal is treated by repeat resection and tendon interposition, proximalization by additional suspension arthroplasty or by arthrodesis between the bases of the first and second metacarpals. In the case of scaphotrapezoidal arthritis, the proximal third of the trapezoid is resected, whereas destabilization of the scaphoid with consecutive carpal collapse may necessitate midcarpal fusion.

Intermediate-Term Outcomes of Trapeziectomy With a Modified Abductor Pollicis Longus Suspension Arthroplasty

Purpose There is limited literature characterizing intermediate-term surgical and clinical outcomes of basal thumb arthritis after trapeziectomy and modified abductor pollicis longus suspension arthroplasty (APLSA). We hypothesized that patients who underwent APLSA would have favorable intermediate-term outcomes. Methods Patients were contacted after APLSA at a median follow-up of 4.8 years (interquartile range, 3.0–6.0 years). Follow-up clinical evaluation included grip, key pinch, and tip pinch strength. We obtained patient-reported outcomes surveys: visual analog pain score and Disabilities of the Arm, Shoulder, and Hand score. Information on demographics, surgical information, and complications was obtained from the electronic medical record and patient interviews. Results This study evaluated 66 hands in 60 patients (51 women and 9 men, average age 60.4 years at surgery). At the time of index surgery, 8% of hands had prior ipsilateral surgery (not involving the carpometacarpal joint), 56% had concurrent ipsilateral surgery (35% carpal tunnel release, 32% hemitrapezoid resection, 22% other soft tissue procedures (mucous cyst excision, ganglion cyst excision, or trigger finger release), 5% metacarpal capsulodesis, and 5% metacarpal arthrodesis. Median time between operation and most recent evaluation was 4.8 years (interquartile range, 3.0–6.0 years). Operative hand grip (18.7 ± 11.1 kg), key pinch (4.7 ± 2.1 kg), and tip pinch (3.2 ± 1.7 kg) strength was 94%, 84%, and 86%, respectively, of nonsurgical grip, key pinch, and tip pinch strength. Median (interquartile range) outcomes were a visual analog pain score of 0.0 (0.0–2.0) and Disabilities of the Arm, Shoulder, and Hand score of 9.1 (2.3–26.1). Conclusions Results at 4.8 years for APLSA demonstrated 84% to 94% grip, key pinch, and tip pinch compared with the contralateral side. Patients experienced little to no pain in the operated joint and minimal disability of the upper extremity at intermediate-term follow-up. Abductor pollicis longus suspension arthroplasty is a favorable procedure for achieving pain relief and functional use associated with basal thumb arthritis. Type of study/level of evidence Prognostic IV.

Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis.

Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon. Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series. Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67-78; SD 4.6). Mean follow-up time was 48.2 months (34-59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE). Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30-40 degrees), extension of 30 degrees (range: 20-42 degrees), radial deviation of 18 degrees (range: 10-30 degrees), and ulnar deviation of 15 degrees (range: 0-25 degrees). The mean key pinch was 4.2 kg (range: 0.5-10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0-19, SD ± 8.9). The PRWE results in four patients were within normal values. Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months. Level of Evidence Level IV, therapeutic study.

Minimum 10-year clinical and radiological follow-up of trapeziectomy with interposition or suspensionplasty for basal thumb arthritis

HypothesisThe aim of this article is to analyze clinical and radiological outcomes of trapeziectomy performed for basal thumb arthritis after a minimum follow-up of 10 years to gain further insight from shorter and medium-term studies reporting satisfactory evolution. MethodsWe reviewed 67 trapeziectomies, operated on by the same senior surgeon after a minimum follow-up of 10 years. The sample included 16 cases of suspensionplasty and 51 interpositions. Clinical outcome evaluated strength, pain, joint amplitude, Kapandji opposition score, Disabilities of the Arm, Shoulder and Hand score, complications and revision surgery. Radiological evaluation criteria included osteoarthritis and collapse of the trapezial void. ResultsAfter a 10-year follow-up, clinical results remained stable despite radiological degradations. Long-term clinical outcomes of trapeziectomy for basal thumb arthritis are very positive, with interpositioning as an isolated procedure appearing, clinically, to be the preferred treatment despite greater radiological degradation when compared to suspensionplasty. ConclusionIn addition to offering insight into minimum 10-year follow-up, this study also pinpoints this paradoxical dissociation of clinical-radiological outcomes. Type of study/level of evidenceTherapeutic III.

Altered Innervation Pattern in Ligaments of Patients with Basal Thumb Arthritis.

Purpose The population of mechanoreceptors in patients with osteoarthritis (OA) lacks detailed characterization. In this study, we examined the distribution and type of mechanoreceptors of two principal ligaments in surgical subjects with OA of the first carpometacarpal joint (CMC1). Methods We harvested two ligaments from the CMC1 of eleven subjects undergoing complete trapeziectomy and suspension arthroplasty: the anterior oblique (AOL) and dorsal radial ligament (DRL). Ligaments were divided into proximal and distal portions, paraffin-sectioned, and analyzed using immunoflourescent triple staining microscopy. We performed statistical analyses using the Wilcoxon Rank Sum test and ANOVA with post-hoc Bonferroni and Tamhane adjustments. Results The most prevalent nerve endings in the AOL and DRL of subjects with OA were unclassifiable mechanoreceptors, which do not currently fit into a defined morphological scheme. These were found in 11/11 (100%) DRLs and 7/11 (63.6%) AOLs. No significant difference existed with respect to location within the ligament (proximal versus distal) of mechanoreceptors in OA subjects. Conclusion The distribution and type of mechanoreceptors in cadavers with no to mild OA differ from those in surgical patients with OA. Where Ruffini endings predominate in cadavers with no to mild OA, unclassifiable corpuscles predominate in surgical patients with OA. These findings suggest an alteration of the mechanoreceptor population and distribution that accompanies the development of OA. Clinical Relevance Identification of a unique type and distribution of mechanoreceptors in the CMC1 of symptomatic subjects provides preliminary evidence of altered proprioception in OA.

Base of thumb injections.

Steroid injections to the trapeziometacarpal joint (TMJ) can offer both diagnostic insight and symptomatic relief for patients with basal thumb arthritis, particularly in the early stages of disease.1 However, correct infiltration of the joint can pose a challenge, especially in the presence of osteophytes. In addition to the unwanted complications of periarticular injection, failure to relieve symptoms could hasten the need for surgery. We suggest that once the TMJ has been located using fluoroscopy, the screen should continue to be monitored as the solution is injected. The visible widening of the TMJ (Fig 1) confirms accurate deployment of the injection. Figure 1 Widening of trapeziometacarpal joint as solution is injected

Analyse de la douleur postopératoire et des résultats fonctionnels précoces dans le traitement de la rhizarthrose. Étude prospective comparative de 74 patientes trapézectomie-interposition vs prothèse MAIA®

Trapeziectomy has been the basis of basal thumb arthritis surgical treatment since the 1950s. This resection arthroplasty has been continuously refined (soft-tissue interposition, ligament reconstruction, spacer implantation, etc.) without leading to a dramatic outcome improvement. Pain decrease is often satisfying in the long-term, but comfort during the early postoperative period may vary. Those disadvantages of trapeziectomy led to the emergence of total trapeziometacarpal prostheses in the 1970s, with a constant improvement of implant design. Few series have compared those two surgical techniques side by side, and prospective ones are even rarer. We compared total trapeziometacarpal prosthesis and trapeziectomy-interposition in the very short term in two similar groups of female patients, to determine whether prosthesis led to faster recovery or not. We compared a total trapeziometacarpal prosthesis (MAIA®) and trapeziectomy-interposition in the immediate and short-term (6months), for objective, subjective, functional criteria, as well as short-term comfort or discomfort. We prospectively followed two comparable cohorts of 47 and 27 female patients above 50years of age, treated for basal joint arthritis with a constrained trapeziometacarpal joint prosthesis or trapeziectomy-interposition, respectively, between April 2009 and February 2010. The patients were followed postoperatively for 6months. Mobility, pain reduction, satisfaction, strength and functional scores were better in the prosthesis group. The pinch strength improved by 30%, the length of the thumb column was maintained, and better correction of the subluxation was obtained in this group. There were six cases of De Quervain's tenosynovitis and one case of loosening due to trauma. In the short-term, the MAIA® trapeziometacarpal prosthesis gives better outcome than trapeziectomy with interposition. This has to be confirmed in the long-term and after revision surgery that will be likely to occur. Clinical relevanceTherapeuthic 3.

The Modified Zancolli Arthroplasty for Basal Thumb Arthritis

The modified Zancolli arthroplasty for basal thumb arthritis is an alternative to different procedures described for this pathology. As most of the methods, it includes complete trapeziectomy. The main difference is that the interposition is made with capsule (resembling Colonna's method for the hips) and that the base of the metacarpal is stabilized in the correct place by a tendon transfer (performed with an accessory of abductor pollicis longus). The main advantage of this method is the short immobilization time (2 wk) and high percentage (95%) of complete pain-free results and a stable and strong thumb in key pinches.

La rhizarthrose chez l’homme : des enjeux différents. Résultats de trois techniques chirurgicales

Basal thumb arthritis is less common in men, but the functional implication is different in this manual worker or active retired population. The objective was to analyse the results of three surgical procedure in an exclusively men's population. Twenty-eight patients (19 partial trapeziectomy with interposition of a chondrocostal autograft, seven total trapeziectomy and two prosthesis), with a mean age of 69 years old, were reviewed at a mean follow-up of 71 months. Mobility and pain were similar in the three populations. But the strength and Dash scores were better in the cartilage group. Radiologically the length of the thumb ray was greater in the cartilage group and no signs of loosening were observed in the prosthesis group. The surgery of reference in this population is the arthrodesis of the trapeziometacarpal joint. But the lack of mobility is disabling, the strength is questionable and painlessness varies due to high rates of non-union. Only one study compared four surgical procedures in an exclusively male population and total trapeziectomy seemed to give the best results. But this technique carries risk of shortening of the thumb ray. Even if the comparison is difficult, the association of partial trapeziectomy with interposition of costal cartilage graft seems to give better stability to the thumb column by preserving length as well as greater strength compared to total trapeziectomy. We advocate this procedure for basal thumb arthritis in men.