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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
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Thumb CarpometacarpalOsteoarthritis
Osteotomy and Arthroplasty-Retrospective study-
Leonor Fernandes
Pedro Simas
Teresa Marques
Júlio André Almeida
Hospital Garcia de Orta - Almada
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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
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Thumb CarpometacarpalOsteoarthritis
� Symptoms
− Pain
− Weakness
− Adduction deformity
� Treatment
− Conservative
− Surgical
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Thumb CarpometacarpalOsteoarthritis
� Surgical treatment
− Trapeziectomy
� Isolated
� Ligamentoplasty
− Extension osteotomy
− Total joint arthroplasty
− Carpometacarpal arthrodesis
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Thumb CarpometacarpalOsteoarthritis
� Surgical treatment
− Trapeziectomy
� Isolated
� Ligamentoplasty
− Extension osteotomy
− Total joint arthroplasty
− Carpometacarpal arthrodesis
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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
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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
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Extension OsteotomyWilson (1973)
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Extension OsteotomyWilson (1973)
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Extension OsteotomyWilson (1973)
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Extension OsteotomyWilson (1973)
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Extension OsteotomyWilson (1973)
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Extension OsteotomyWilson (1973)
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Extension OsteotomyWilson (1973)
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Total Joint Arthroplasty
Caffinière and Aucouturier (1976)
� Implant
− ARPE ® (Biomet) - J.J. Comtet 1994
− Non-cemented
− Calcium hydroxyapatite
− Modular
� Metacarpal stem
� Head
� Cup
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Total Joint Arthroplasty
� Implant
− ARPE ® (Biomet)
− Modular
� Metacarpal stem
� Head
� Cup
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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)
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Total Joint Arthroplasty
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Total Joint Arthroplasty
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Total Joint Arthroplasty
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Total Joint Arthroplasty
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Total Joint Arthroplasty
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Total Joint Arthroplasty
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Total Joint Arthroplasty
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Results
� Pre-operative comparison
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Results
� Pre-operative comparison
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Results
� Post-operative comparison
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Discussion
� Extension Osteotomy
− Satisfaction: Excellent or good 90%
− Pinch and grip strengths improvement
− Few complications
− Advantage in the young patient and active patient
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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
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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
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OBRIGADA !