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J Wrist Surg 2024; 13(02): 181-190
DOI: 10.1055/s-0043-1777764
Emerging Technologies and New Technological Concepts

Outcomes of Thumb Carpometacarpal Joint Osteoarthritis Treated with Arthroscopic Fusion

Esther Ching San Chow 
1   Department of Orthopaedics and Traumatology, United Christian Hospital, Hong Kong
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Abstract

Background The thumb carpometacarpal joint (CMCJ) osteoarthritis is one of the most common pathologies in the hand with controversial treatment options.

Description of Technique Describe the use of arthroscopic technique for thumb CMCJ arthrodesis and the clinical outcome.

Patients and Methods Cases with Eaton III thumb CMCJ osteoarthritis treated with arthroscopic arthrodesis were reviewed. Patient evaluations include: grip strength, pinch strength, range of motion, Kapandji score, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the visual analog scores for pain. All cases were assessed before the surgery and at 3, 6, 12, and 24 months after surgery. Radiographs were reviewed.

Results There were total 16 patients with 18 arthrodesis performed. The average age was 62.2 years with M:F ratio of 2:7. The average follow-up time was 57.2 months. There was improvement of pain score as early as at postop 3 months (p < 0.001) and continued to improve at 6, 12, and 24 months. There was improvement of grip strength and pinch strength at 12 and 24 months (p < 0.001). The DASH score showed improvement as early as at 3 months (p = 0.012). There was a reduction of Kapandji score and interphalangeal joint motion at 3 months postop, but these returned to normal at 6 months. There was no major complication. There was one case of nonunion (5.6%).

Conclusion Arthroscopic arthrodesis is a feasible treatment option and provides excellent pain relief, restore thumb strength and stability, retain functional thumb mobility, and hence improvement in hand function.

Keywords

first carpometacarpal joint osteoarthritis - thumb base arthritis - first CMCJ arthroscopy - first CMCJ fusion arthrodesis

Note

Approved by Research Ethics Committee (Ref: KC/KE-20–0259/ER-2).


Location Where the Work was Performed

United Christian Hospital, Hong Kong.




Publication History

Received: 13 May 2023

Accepted: 23 November 2023

Article published online:
25 January 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 1994; 19 (03) 340-341
    CrossrefPubMedGoogle Scholar
  • 2 Pellegrini Jr VD. Osteoarthritis at the base of the thumb. Orthop Clin North Am 1992; 23 (01) 83-102
    CrossrefPubMedGoogle Scholar
  • 3 Hentz VR. Surgical treatment of trapeziometacarpal joint arthritis: a historical perspective. Clin Orthop Relat Res 2014; 472 (04) 1184-1189
    CrossrefPubMedGoogle Scholar
  • 4 Muller GM. MuÌ^ller GM. Arthrodesis of the trapezio-metacarpal joint for osteoarthritis. J Bone Joint Surg Br 1949; 31B (04) 540-542 , illust
    CrossrefPubMedGoogle Scholar
  • 5 Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2015; 2015 (02) CD004631
    PubMedGoogle Scholar
  • 6 Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am 2011; 36 (01) 157-169
    CrossrefPubMedGoogle Scholar
  • 7 Menon J. Arthroscopic management of trapeziometacarpal joint arthritis of the thumb. Arthroscopy 1996; 12 (05) 581-587
    CrossrefPubMedGoogle Scholar
  • 8 Berger RA. A technique for arthroscopic evaluation of the first carpometacarpal joint. J Hand Surg Am 1997; 22 (06) 1077-1080
    CrossrefPubMedGoogle Scholar
  • 9 Wilkens SC, Bargon CA, Mohamadi A, Chen NC, Coert JH. A systematic review and meta-analysis of arthroscopic assisted techniques for thumb carpometacarpal joint osteoarthritis. J Hand Surg Eur Vol 2018; 43 (10) 1098-1105
    CrossrefPubMedGoogle Scholar
  • 10 Carroll RE, Hill NA. Arthrodesis of the carpo-metacarpal joint of the thumb. J Bone Joint Surg Br 1973; 55 (02) 292-294
    CrossrefPubMedGoogle Scholar
  • 11 Klimo GF, Verma RB, Baratz ME. The treatment of trapeziometacarpal arthritis with arthrodesis. Hand Clin 2001; 17 (02) 261-270
    CrossrefPubMedGoogle Scholar
  • 12 Hartigan BJ, Stern PJ, Kiefhaber TR. Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition. J Bone Joint Surg Am 2001; 83 (10) 1470-1478
    CrossrefPubMedGoogle Scholar
  • 13 Rizzo M, Moran SL, Shin AY. Long-term outcomes of trapeziometacarpal arthrodesis in the management of trapeziometacarpal arthritis. J Hand Surg Am 2009; 34 (01) 20-26
    CrossrefPubMedGoogle Scholar
  • 14 Leach RE, Bolton PE. Arthritis of the carpometacarpal joint of the thumb. Results of arthrodesis. J Bone Joint Surg Am 1968; 50 (06) 1171-1177
    CrossrefPubMedGoogle Scholar
  • 15 Mattsson HS. Arthrodesis of the first carpo-metacarpal joint for osteoarthritis. Acta Orthop Scand 1969; 40 (05) 602-607
    CrossrefPubMedGoogle Scholar
  • 16 Eiken O, Carstam N. Functional assessment of basal joint fusion of the thumb. Scand J Plast Reconstr Surg 1970; 4 (02) 122-125
    PubMedGoogle Scholar
  • 17 Stark HH, Moore JF, Ashworth CR, Boyes JH. Fusion of the first metacarpotrapezial joint for degenerative arthritis. J Bone Joint Surg Am 1977; 59 (01) 22-26
    CrossrefPubMedGoogle Scholar
  • 18 Pardini AG, Lazaroni AP, Tavares KE. Compression arthrodesis of the carpometacarpal joint of the thumb. Hand 1982; 14 (03) 291-294
    CrossrefPubMedGoogle Scholar
  • 19 Cavallazzi RM, Spreafico G. Trapezio-metacarpal arthrodesis today: why?. J Hand Surg [Br] 1986; 11 (02) 250-254
    CrossrefPubMedGoogle Scholar
  • 20 Alberts KA, Engkvist O. Arthrodesis of the first carpometacarpal joint. 33 cases of arthrosis. Acta Orthop Scand 1989; 60 (03) 258-260
    CrossrefPubMedGoogle Scholar
  • 21 Clough DA, Crouch CC, Bennett JB. Failure of trapeziometacarpal arthrodesis with use of the Herbert screw and limited immobilization. J Hand Surg Am 1990; 15 (05) 706-711
    CrossrefPubMedGoogle Scholar
  • 22 Karlsson MK. Arthrodesis of the trapeziometacarpal joint. Scand J Plast Reconstr Surg Hand Surg 1991; 25 (02) 167-171
    CrossrefPubMedGoogle Scholar
  • 23 Bamberger HB, Stern PJ, Kiefhaber TR, McDonough JJ, Cantor RM. Trapeziometacarpal joint arthrodesis: a functional evaluation. J Hand Surg Am 1992; 17 (04) 605-611
    CrossrefPubMedGoogle Scholar
  • 24 Caputo RJ, Bennett JB. Power staple fixation in trapeziometacarpal arthrodesis. J Hand Surg Am 1993; 18 (05) 926-929
    CrossrefPubMedGoogle Scholar
  • 25 Chamay A, Piaget-Morerod F. Arthrodesis of the trapeziometacarpal joint. J Hand Surg [Br] 1994; 19 (04) 489-497
    CrossrefPubMedGoogle Scholar
  • 26 Lisanti M, Rosati M, Spagnolli G, Luppichini G. Trapeziometacarpal joint arthrodesis for osteoarthritis. Results of power staple fixation. J Hand Surg [Br] 1997; 22 (05) 576-579
    CrossrefPubMedGoogle Scholar
  • 27 Hartigan BJ, Stern PJ, Kiefhaber TR. Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition. J Bone Joint Surg Am 2001; 83 (10) 1470-1478
    CrossrefPubMedGoogle Scholar
  • 28 Fulton DB, Stern PJ. Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study. J Hand Surg Am 2001; 26 (01) 109-114
    CrossrefPubMedGoogle Scholar
  • 29 Forseth MJ, Stern PJ. Complications of trapeziometacarpal arthrodesis using plate and screw fixation. J Hand Surg Am 2003; 28 (02) 342-345
    CrossrefPubMedGoogle Scholar
  • 30 Rizzo M, Moran SL, Shin AY. Long-term outcomes of trapeziometacarpal arthrodesis in the management of trapeziometacarpal arthritis. J Hand Surg Am 2009; 34 (01) 20-26
    CrossrefPubMedGoogle Scholar
  • 31 De Smet L, Van Meir N, Verhoeven N, Degreef I. Is there still a place for arthrodesis in the surgical treatment of basal joint osteoarthritis of the thumb?. Acta Orthop Belg 2010; 76 (06) 719-724
    PubMedGoogle Scholar
  • 32 Smeraglia F, Soldati A, Orabona G, Ivone A, Balato G, Pacelli M. Trapeziometacarpal arthrodesis: is bone union necessary for a good outcome?. J Hand Surg Eur Vol 2015; 40 (04) 356-361
    CrossrefPubMedGoogle Scholar
  • 33 Abe Y, Tokunaga S. Surgical technique and clinical results for trapeziometacarpal arthrodesis using locking plate fixation in women aged 50 years or older. Plast Reconstr Surg 2015; 136 (03) 521-528
    CrossrefPubMedGoogle Scholar
  • 34 Hayashi M, Uchiyama S, Nakamura K, Itsubo T, Momose T, Kato H. Arthrodesis of the carpometacarpal joint of the thumb with plate fixation and bone grafting: a retrospective review. J Orthop Sci 2015; 20 (02) 302-306
    CrossrefPubMedGoogle Scholar
  • 35 Spekreijse KR, Selles RW, Kedilioglu MA. et al. Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis: a 5-year follow-up. J Hand Surg Am 2016; 41 (09) 910-916
    CrossrefPubMedGoogle Scholar
  • 36 Jiménez-Díaz V, Cecilia-López D, Porras-Moreno MÁ, Muñoz-Sánchez G, García-Lamas L, Jara-Sánchez F. Arthrodesis of the thumb carpometacarpal joint using a quadrangular plate: surgical technique and long-term results of 70 patients. Eur J Orthop Surg Traumatol 2017; 27 (07) 909-915
    CrossrefPubMedGoogle Scholar
  • 37 Li J, Li D, Tian G, Zhang W. Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis. J Orthop Surg Res 2019; 14 (01) 404
    CrossrefPubMedGoogle Scholar
  • 38 van Laarhoven CMCA, Schrier VJMM, van Heijl M, Schuurman AH. Arthrodesis of the carpometacarpal thumb joint for osteoarthritis; long-term results using patient-reported outcome measurements. J Wrist Surg 2019; 8 (06) 489-496
    Article in Thieme ConnectPubMedGoogle Scholar