Thumb Carpometacarpal Osteoarthritis

Abstract

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.