Update on Thumb Basal Joint Arthritis Surgery

Abstract

Learning Objectives: After studying this article, the participant should be able to: 1. Comprehend anatomy and biomechanics of the normal and arthritic trapeziometacarpal joint. 2. Evaluate best evidence for diagnosis and for operative and nonoperative treatment of thumb osteoarthritis. 3. Understand treatment pitfalls of basilar joint arthritis and complication avoidance. Summary: Articular and ligamentous anatomy of the trapeziometacarpal joint enables complex motions. Disability from arthritis, common at the trapeziometacarpal joint, is debilitating. Furthering the understanding of how trapeziometacarpal arthritis develops can improve treatment. The authors provide current best evidence for diagnosis and treatment of basilar joint arthritis. Pitfalls in treatment are discussed.

Liparthroplasty for Thumb Carpometacarpal Joint Osteoarthritis: A Case Series with Median 5 Years of Follow-Up

“…Regarding invasive thumb CMC joint surgery, there is hardly any other joint with a higher range of various surgical approaches for OA described in the literature. Although total joint arthroplasty offered at our institution represents an increasingly popular method, currently any trapeziectomy with ligament reconstruction technique is the most commonly performed technique because of durably good outcomes over several decades in the literature [ 18 ]. Trost et al [ 18 ] proved a very recent overview of currently available surgical methods and their respective functional advantages, complication profiles, and recovery times, concluding that there is still no hard evidence that one technique is superior to all others.…”

“…Although total joint arthroplasty offered at our institution represents an increasingly popular method, currently any trapeziectomy with ligament reconstruction technique is the most commonly performed technique because of durably good outcomes over several decades in the literature [ 18 ]. Trost et al [ 18 ] proved a very recent overview of currently available surgical methods and their respective functional advantages, complication profiles, and recovery times, concluding that there is still no hard evidence that one technique is superior to all others. Given the fact that symptoms of thumb CMC joint OA usually start in a patient’s late 50s [ 19 ], liparthroplasty gives the opportunity to delay joint-replacing surgery, involving longer recovery times after patients have reached retirement age [ 15 ].…”

Selective Denervation for the Thumb Carpometacarpal Joint

“…However, painful nonunion and limited range of motion (ROM) are the issues while performing this procedure. 15 Therefore, for early-stage arthritis, joint-preserving procedures such as first metacarpal extension osteotomy, arthroscopy, synovial debridement, and capsulotomy have been proposed, but only in a few cases and with limited evidence. 16 In a given circumstance, selective denervation is introduced as an alternative surgical option for thumb CMC joint arthritis.…”

“…Therefore, for young individuals (aged ≤50 years) who engage in heavy manual labor, thumb arthrodesis is recommended because of effective pain relief and strengthened pinch grip. However, painful nonunion and limited range of motion (ROM) are the issues while performing this procedure 15 . Therefore, for early-stage arthritis, joint-preserving procedures such as first metacarpal extension osteotomy, arthroscopy, synovial debridement, and capsulotomy have been proposed, but only in a few cases and with limited evidence 16 .…”