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Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis.

Abstract

PURPOSE
Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women. Many different surgical techniques have been proposed for extensive degenerative arthritis of the first carpometacarpal (CMC) joint. Joint replacement has been an effective treatment of this condition. The purpose of this article is to present the outcome of a total cemented trapeziometacarpal implant in the treatment of more advanced stages of this disease.
METHODS
Total joint arthroplasty of the trapeziometacarpal joint was performed on 26 thumbs in 25 patients to treat advanced osteoarthritis (Eaton and Littler stages III and IV) between 1998 and 2003. Indications for surgery after failure of conservative treatment were severe pain, loss of pinch strength, and diminished thumb motion that limited activities of daily living. A trapeziometacarpal joint prosthesis was the implant used in this series. The average follow-up time was 59 months.
RESULTS
At the final follow-up evaluation, thumb abduction averaged 60 degrees and thumb opposition to the base of the small finger was present. The average pinch strength was 5.5 kg (85% of nonaffected side). One patient had posttraumatic loosening, which was revised with satisfactory results. Radiographic studies at the final follow-up evaluations did not show signs of atraumatic implant loosening. One patient complained of minimal pain, and the remaining 24 patients were pain free.
CONCLUSIONS
In our series, total joint arthroplasty of the thumb CMC joint has proven to be efficacious with improved motion, strength, and pain relief. We currently recommend this technique for the treatment of stage III and early stage IV osteoarthritis of the CMC joint in older patients with low activity demands.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.

Links

  • Publisher Full Text
  • Authors

    Badia A, Sambandam SN

    Source

    The Journal of hand surgery 31:10 2006 Dec pg 1605-14

    MeSH

    Aged
    Arthroplasty, Replacement
    Bone Cements
    Carpometacarpal Joints
    Female
    Humans
    Joint Prosthesis
    Male
    Osteoarthritis
    Pain Measurement
    Pinch Strength
    Range of Motion, Articular
    Severity of Illness Index
    Thumb
    Trapezium Bone

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    17145380