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Thumb Carpometacarpal Osteoarthritis
Unidade de Cirurgia
da mão e membro superior
Hospital Garcia de Orta – Almada
Júlio André
Fernando Cruz
Mª José Maio
HOSPITAL GARCIA DE ORTA E.P.E.HOSPITAL GARCIA DE ORTA E.P.E.
ServiServiçço de Ortopedia Traumatologiao de Ortopedia Traumatologia
Director Dr. Craveiro LopesDirector Dr. Craveiro Lopes
Thumb CarpometacarpalOsteoarthritis
Osteotomy and Arthroplasty-Retrospective study-
Leonor Fernandes
Pedro Simas
Teresa Marques
Júlio André Almeida
Hospital Garcia de Orta - Almada
Thumb CarpometacarpalOsteoarthritis
� Prevalence
− Increases with age
− Female to male ratio – 6 to 1
� 1/3 post menopausal women – osteoarthritis in X ray
� 1/3 of these – symptoms
Thumb CarpometacarpalOsteoarthritis
� Symptoms
− Pain
− Weakness
− Adduction deformity
� Treatment
− Conservative
− Surgical
Thumb CarpometacarpalOsteoarthritis
� Surgical treatment
− Trapeziectomy
� Isolated
� Ligamentoplasty
− Extension osteotomy
− Total joint arthroplasty
− Carpometacarpal arthrodesis
Thumb CarpometacarpalOsteoarthritis
� Surgical treatment
− Trapeziectomy
� Isolated
� Ligamentoplasty
− Extension osteotomy
− Total joint arthroplasty
− Carpometacarpal arthrodesis
Thumb CarpometacarpalOsteoarthritis
� Retrospective study
− Extension osteotomy/Total joint arthroplasty
− Stage II or III (Eaton-Littler)
− Minimum one year follow-up
− 23 patients (2003-2008)
� 10 patients osteotomy group
� 13 patients arthroplasty group
Extension OsteotomyWilson (1973)
� Surgical procedure
− General anesthesia/Nervous block/
− Tourniquet
− Zigzag incision over the dorsal aspect
of the 1st metacarpal
− Closing wedge osteotomy
− Fixation with 2 Kirschner wires
− Dressing
Extension OsteotomyWilson (1973)
Extension OsteotomyWilson (1973)
Extension OsteotomyWilson (1973)
Extension OsteotomyWilson (1973)
Extension OsteotomyWilson (1973)
Extension OsteotomyWilson (1973)
Extension OsteotomyWilson (1973)
Total Joint Arthroplasty
Caffinière and Aucouturier (1976)
� Implant
− ARPE ® (Biomet) - J.J. Comtet 1994
− Non-cemented
− Calcium hydroxyapatite
− Modular
� Metacarpal stem
� Head
� Cup
Total Joint Arthroplasty
� Implant
− ARPE ® (Biomet)
− Modular
� Metacarpal stem
� Head
� Cup
Total Joint Arthroplasty
� Surgical procedure
− General anesthesia/Nervous block/Tourniquet
− Dorso-radial incision
− Metacarpal andTrapezial osteotomy
− Metacarpal reaming
− Definitive components
− Soft tissue reconstruction
− Splint (4-6w)
Total Joint Arthroplasty
Total Joint Arthroplasty
Total Joint Arthroplasty
Total Joint Arthroplasty
Total Joint Arthroplasty
Total Joint Arthroplasty
Total Joint Arthroplasty
Results
� Pre-operative comparison
Results
� Pre-operative comparison
Results
� Post-operative comparison
Discussion
� Extension Osteotomy
− Satisfaction: Excellent or good 90%
− Pinch and grip strengths improvement
− Few complications
− Advantage in the young patient and active patient
Discussion
� Total Joint Arthroplasty
− Satisfaction: Excellent or good 80%
− Complications
� 1 Thumb flexion deficit; 2 dislocations
− Reoperations: 2
− Good surgical option if low functional demands
Conclusion
� Controversy exists regarding the most effective
surgical approach
� Satisfaction rates are high with both techniques,
if
� Appropriate patient selection and knowledge of
technical considerations
OBRIGADA !