Arthroscopic Management of Thumb Carpometacarpal Joint Arthritis and Pathology

Barrera, Janos A.; Yao, Jeffrey

doi:10.1016/j.hcl.2021.11.002

Cited by 5 publications

(5 citation statements)

References 88 publications

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“…However, previous studies evaluating the efficacy of surgical intervention have shown varying levels of benefit in terms of pain reduction and improved function and have reported adverse event rates ranging from 10 to 22%, depending on the procedure used . Therefore, it is important to identify the most effective management strategies to improve pain and function in the osteoarthritis population …”

Section: Introductionmentioning

confidence: 99%

“…6 Therefore, it is important to identify the most effective management strategies to improve pain and function in the osteoarthritis population. 7 The ultimate situation of the need for mobilization techniques is amputation and late reconstruction. Traumatic finger (index finger) amputation is the most common type of very serious upper limb injury.…”

Section: ■ Introductionmentioning

confidence: 99%

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Evaluation of In Vivo Biocompatibility in Preclinical Studies of a Finger Implant Medical Device Correlated with Mechanical Properties and Microstructure

Major,

Grajoszek,

Byrski

et al. 2023

ACS Appl. Mater. Interfaces

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The aim of the experiment was to evaluate the biocompatibility of four 3D-printed biomaterials planned for use in the surgical treatment of finger amputees: Ti-6Al-4 V (Ti64), ZrO 2 −Al 2 O 3 ceramic material (ATZ20), and osteoconductive (anodized Ti64) and antibacterial (Hydroxyapatite, HAp) coatings that adhere well to materials dedicated to finger bone implants. The work concerns the correlation of mechanical, microstructural, and biological properties of dedicated materials. Biological tests consisted of determining the overall cytotoxicity of the organism on the basis of in vivo tests carried out in accordance with the ISO 10993-6 and ISO 10993-11 standards. Clinical observations followed by diagnostic examinations, histopathological evaluation, and biochemical characterization showed no significant differences between control and tested groups of animals. The wound healed without complication, and no pathological effects were found. The wear test showed the fragility of the hydroxyapatite thin layer and the mechanical stability of the zirconia-based ceramic substrate. Electron microscopy observations revealed the layered structure of tested substrates and coatings.

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Section: Introductionmentioning

confidence: 99%

Section: ■ Introductionmentioning

confidence: 99%

Evaluation of In Vivo Biocompatibility in Preclinical Studies of a Finger Implant Medical Device Correlated with Mechanical Properties and Microstructure

Major,

Grajoszek,

Byrski

et al. 2023

ACS Appl. Mater. Interfaces

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“…76,77 Available studies on outcomes after pyrocarbon disc placement are mainly small cohort studies with a maximum of 46 people. 76,78,79 In Chapter 6 we will analyze a retrospective cohort of 137 people (164 thumbs) after pyrocarbon disc placement. Patient reported outcome measures, patient satisfaction, thumb strength and motion are assessed at a minimum of five years after surgery (median 7.2 years, range 5 to 11).…”

Section: Part Three | Surgical Interventions For Thumb Carpometacarpa...mentioning

confidence: 99%

“…HONcode, n (%) 14 (21) Nonprofit, n (%) 19 (28) Both treatment options discussed, n (%) 53 (79) Clear preference for treatment, n (%) None 44 (66)…”

Section: Variables Valuesmentioning

confidence: 99%

“…Generally speaking, we can define two ways to approach this problem. Some explore new avenues of invasive treatment, such as intra-articular injection of autologous fat (liparthroplasty), 76,77 arthroscopic debridement or synovectomy only, 78,79 or joint distraction. Others move away from invasive procedures and focus on adaptation and resilience, while waiting for the natural history and regression to the mean to reduce symptoms.…”

Section: The Future Of Cmc1 Osteoarthritis Managementmentioning

confidence: 99%

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Thumb Carpometacarpal Osteoarthritis

Ottenhoff

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SUMMARY Osteoarthritis of the basal thumb joint is part of normal human aging: everyone gets it if we live long enough. Thumb pain can cause reduced pinch strength and impaired hand capability such as difficulty opening jars or turning a key. Symptom intensity does not correlate with the severity of basal thumb osteoarthritis on radiographs. Acceptance and adaptation in daily life are the primary treatment goals. This can often be achieved with splints and analgesics; surgery is not necessary. Notwithstanding, numerous surgical options are available but there is no consensus about which surgical treatment is most effective. The aim of this thesis was to explore patients’ and surgeons’ perspectives on basal thumb osteoarthritis, and discuss outcomes of surgical treatment by pyrocarbon disc and joint distraction. CONCLUSIONS 1. Online information on CMC1 osteoarthritis is often difficult to read and biased in favor of a particular treatment. Clinicians should be prepared to gently reorient any misconceptions about the etiology (it is not an acute injury but part of human aging) and on the effectiveness of treatment options (adaptation is the foundation of healthcare, a surgical “quick fix” does not exist). 2. There is surgeon-to-surgeon variation in testing (obtaining radiographs) and treatment (injection and surgery) for CMC1 osteoarthritis. Surgeons seem to base their recommendations for operative treatment largely on subjective factors. Shared decision making and decision aids may help ensure that a treatment choice is not based on misconceptions or surgeon preferences, and instead reflects the personal values of the patient. 3. If implant displacement occurs after pyrocarbon disc interposition arthroplasty for CMC1 osteoarthritis, most people do not experience pain or limitation in their daily activities. Revision surgery is performed in about 1 out of 10 people mainly because of dissatisfaction with pain alleviation (which does not correspond with radiographic findings). Given this lack of correspondence, the role of the pyrocarbon interposition is open to debate, and revision surgery is not needed based on the radiographic findings alone. 4. Temporary joint distraction is a technically feasible treatment for people with CMC1 osteoarthritis. Application of this technique was associated with a second surgery for arthroplasty among one of 20 patients within two years. Larger, randomized, comparative studies are needed to be sure that this distraction alleviates symptoms better than simulated distraction and to assess the exact place of joint distraction in treatment of CMC1 osteoarthritis.

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