Treatment of Basilar Thumb Arthritis

Gottschalk, Michael B.; Patel, Nick N.; Boden, Allison L.; Kakar, Sanjeev

doi:10.2106/jbjs.rvw.17.00156

Cited by 27 publications

(32 citation statements)

References 94 publications

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“…For patients with mild osteoarthritic changes (Eaton classification stage 1 or 2), ligamentoplasty, arthroscopic synovectomy, and first metacarpal osteotomy are selected for thumb CMC joint preservation surgery, whereas, for patients with advanced osteoarthritic changes (Eaton classification stage 3 or 4), arthroplasty such as ligament reconstruction and tendon interposition, arthrodesis, and artificial joint replacement is generally selected as the thumb CMC joint non-preservation surgery. Although the clinical outcome is generally good with each type of treatment [ 30 ], Ogawa et al have reported symptomatic improvement with joint preservation surgery even in patients with advanced osteoarthritic changes [ 25 ]. We believe that joint preservation surgery is preferable for younger patients or those who are involved in heavy labor, although a risk of osteoarthritic change progression exists even after a long-term joint preservation surgery.…”

Section: Discussionmentioning

confidence: 99%

Effects of Magnetic Resonance Imaging With Axial Traction of the Thumb Carpometacarpal Joint on Articular Cartilage Visibility: A Feasibility Study

Ikumi¹,

Kohyama²,

Okuwaki³

et al. 2022

Cureus

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The objective of this study was to verify the usefulness of magnetic resonance imaging (MRI) with axial traction of the thumb for observing articular cartilage. Materials and methodsEleven healthy adult volunteers (39.7 ± 7.4 years) without thumb carpometacarpal joint arthritis or trauma were included in this study. A 3-tesla (3T) MRI (Magnetom Skyra, Siemens Healthineers AG, Munich, Germany) of the right thumb with axial traction applied by a finger trap with three traction weights (0, 2, and 5 kg) was performed. A 3D T2* multiecho data imaging combination (MEDIC) was selected to visualize the articular cartilage. After multiplanar reconstruction, sagittal and coronal images of the thumb carpometacarpal joint were used to evaluate the articular cartilage visibility and joint space widths at five locations. Articular cartilage visibility was evaluated using our original classification method that used the percentage of the cartilage detectable area. The Friedman test was used to compare the differences between each traction weight and location. ResultsArticular cartilage visibility significantly improved with axial traction. The average joint space widths with the 5-kg application were 1.9 ± 0.8, 3.9 ± 0.6, 2.0 ± 0.9, 3.9 ± 1.1, and 2.5 ± 1.4 mm at the center, volar edge, dorsal edge, radial edge, and ulnar edge, respectively. The joint space widths significantly increased proportionally with the traction weight at all locations. The joint space widths at the volar and radial edges were significantly greater than those at other locations. ConclusionApplying axial traction to the thumb increased the joint space widths and improved the visibility of the articular cartilage in the carpometacarpal joint on MRI.

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Section: Discussionmentioning

confidence: 99%

Effects of Magnetic Resonance Imaging With Axial Traction of the Thumb Carpometacarpal Joint on Articular Cartilage Visibility: A Feasibility Study

Ikumi¹,

Kohyama²,

Okuwaki³

et al. 2022

Cureus

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“…Thumb CMC arthroscopic hemi- or complete trapeziectomy theoretically overcomes some of these issues, preserving the native static stabilizers of the CMC joint, including the capsule, dorsoradial, and volar beak ligaments. 70 71 72 73 74 Although there have been many case series on CMC arthroscopic outcomes, 32 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 there remains a paucity of large or comparative studies. Therefore, this study assessed the overall outcomes of thumb CMC arthroscopic interventions utilized to treat CMC arthritis, as well as compared the need to perform a soft tissue interposition or suspension after hemitrapeziectomy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of First Carpometacarpal Osteoarthritis with Arthroscopy: A Systematic Review

et al. 2022

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Background First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated superiority in managing this disease. Purpose This study performed a systematic review of arthroscopic techniques for treating first CMC arthritis to assess the effectiveness of different arthroscopic techniques. Methods Grip strength, pinch strength, visual analog scale, the Disability of Arm, Shoulder, and Hand (DASH) score, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed, comparing outcomes of (1) trapeziectomy of any type versus debridement alone and (2) trapeziectomy alone versus interposition versus suspension techniques. Results Preoperative and postoperative scores significantly improved for DASH scores and pain at rest and with activity with variable improvements in ROM. Complications occurred in 13% of cases in publications that reported complications. When comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in interposition and suspension subgroups. Conclusions The existing literature describes a predominantly female population with Eaton-Littler stage II and III disease. In the subgroup analysis, arthroscopic techniques involving a trapeziectomy seem to be more effective at lowering pain scores compared to techniques involving debridement alone. Likewise, interposition and suspension techniques may show improved outcomes compared to techniques involving trapeziectomy alone. Level of evidence This is a Level III study.

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“…A recent critical literature review published by Gottschalk et al 19 investigated current treatment options for basilar thumb arthritis. According to the authors, trapeziectomy, trapeziectomy with distraction arthroplasty, and trapeziectomy with ligament tendon reconstruction interposition (LTRI) are the surgical techniques supported by good evidence (level I studies with consistent findings) for recommending intervention.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Review of Long-term Outcomes of Patients Undergoing CMC Arthroplasty With Interposition Scaffold

Marcuzzi

Colzani

Acciaro

et al. 2020

Hand (New York, N,Y.)

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Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioabsorbable scaffolds have begun to be proposed to avoid the use of other biological tissues or artificial permanent devices. Methods: In this study, we evaluated the long-term outcomes of poly-ld-lactic acid scaffold in interposition arthroplasty in a series of patients treated in our department. Results: Strength, range of motion, and pain improved after the intervention and lasted over the years; nonetheless, most of the radiographs showed a progressive collapse of the first metacarpal. Conclusions: Despite radiological findings, we believe that poly-ld-lactic acid scaffold can be considered a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty, with long-lasting satisfactory clinical results.

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Treatment of Basilar Thumb Arthritis

Cited by 27 publications

References 94 publications

Effects of Magnetic Resonance Imaging With Axial Traction of the Thumb Carpometacarpal Joint on Articular Cartilage Visibility: A Feasibility Study

Effects of Magnetic Resonance Imaging With Axial Traction of the Thumb Carpometacarpal Joint on Articular Cartilage Visibility: A Feasibility Study

Treatment of First Carpometacarpal Osteoarthritis with Arthroscopy: A Systematic Review

Retrospective Review of Long-term Outcomes of Patients Undergoing CMC Arthroplasty With Interposition Scaffold

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