Clinical Results of 40 Consecutive Basal Thumb Prostheses and No CRPS Type I After Vitamin C Prophylaxis~!2009-10-04~!2009-12-30~!2010-02-17~!

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.

The role of vitamin C in the treatment of pain: new insights

“…Calcitonin + 3 g/day vitamin C (N = 11) for 2 weeks ii. Pain relief in 73%, marked ↓ pain in 45% Uncontrolled prospective Arthritic joint replacement surgery [ 54 ] a 500 mg/day oral vitamin C (N = 34) for 50 days 0% CRPS cases Paget’s disease of bone [ 58 ] 3 g/day oral vitamin C (N = 16) for 2 weeks ↓ Pain in 50%, no pain in 20% (within 5-7 days) Case report Rheumatoid arthritis [ 56 ] 50 g IV vitamin C twice/week for 4 weeks Before: 100% pain (QLQ) After: 0% pain IV intravenous, VAS visual analog scale, QLQ quality of life questionnaire * P < 0.05 a Study was included in CRPS meta-analysis [ 48 – 52 ] …”

“…Patients undergoing joint replacement surgery for osteoarthritis were administered 0.5 g/day prophylactic vitamin C for 50 days post-surgery (Table 1 ) [ 53 , 54 ]. Although osteoarthritis of the carpometacarpo joint can be complicated by CRPS, no cases of CRPS were observed under vitamin C prophylaxis.…”

Aktuelle Trends bei der Implantation der Touch-Prothese am Daumensattelgelenk: Ergebnisse des 1. deutschsprachigen Anwendertreffens

“…Es wurde in den Standarddatenbanken (PubMed, ScienceDirect, Cochrane Library) von 1997 bis März 2023 nach den Schlüsselwörtern CMC1, Daumengrundgelenk, Rhizarthrose, Totalgelenkimplantat, Prothese, Arthroplasty, Implantate gesucht, und zwar sowohl in englischer als auch in französischer Sprache, da viele Studien in französischer Sprache veröffentlicht wurden. Insgesamt wurden 4 216 Fälle von Totalendoprothesen an der Daumenbasis in 82 Studien aus den letzten 25 Jahren veröffentlicht 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 ...…”

Use of vitamin C as placebo in anesthesiology

“…Noteworthy, earlier animal studies have suggested that there is a close relationship between recovery from anesthesia and extracellular ascorbic acid levels ( 2 ). Vitamin C has showed pain relieving effects ( 3 ) namely in complex regional pain syndrome ( 4 ), post herpetic neuralgia ( 5 ), migraine headache ( 6 ) and myalgia associated with the administration of suxamethonium ( 7 ). Moreover, the placebo tablet should be identical-looking with similar color, taste, and smell with the treatment drug.…”