Clinical Orthopaedics and Related Research®

, Volume 472, Issue 4, pp 1166–1172 | Cite as

Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

Symposium: Thumb Carpometacarpal Arthritis

Abstract

Background

Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice with a variety of treatment options. Arthroscopic procedures can preserve all or part of the trapezium in the setting of treatment of basilar joint arthritis, and such procedures (even without stabilization or ligament reconstruction) have high reported success rates. However, little is documented about the limitations of these procedures in terms of patient selection, the optimal type of interposition, if any, and rehabilitation.

Questions/purposes

A systematic review was performed to determine the influence of (1) interposition material (manufactured, biological, or none); and (2) patient-related factors (including metacarpophalangeal joint hyperextension, ligamentous laxity, and severity of arthritis) on pain, functional scores, and postoperative complications unique to each approach.

Methods

A systematic review of the English language literature regarding thumb basilar joint arthritis and arthroscopic partial trapeziectomy or débridement was performed. Those procedures including ligament reconstruction or stabilization were excluded.

Results

Biological materials and no interposition were both associated with satisfactory improvement and low rates of complications; complication rates with synthetic materials were higher. Eaton Stages I to III were treated successfully with this technique. The effect of scaphotrapeziotrapezoid (STT) changes was variably described across series. In most series, metacarpophalangeal hyperextension did not seem to have an adverse effect on outcomes, although these patients were excluded in some series.

Conclusions

Arthroscopic débridement with or without interposition can be used for treatment of Eaton Stages I to III CMC osteoarthritis with satisfactory outcomes. Some series suggest satisfactory outcomes in the setting of STT changes and metacarpophalangeal hyperextension.

References

  1. 1.
    Abzug JM, Osterman AL. Arthroscopic hemiresection for stage II–III trapeziometacarpal osteoarthritis. Hand Clin. 2011;27:347–354.PubMedGoogle Scholar
  2. 2.
    Adams JE, Merten SM, Steinmann SP. Arthroscopic interposition arthroplasty of the first carpometacarpal joint. J Hand Surg Eur. 2007;32:268–274.CrossRefGoogle Scholar
  3. 3.
    Adams JE, Steinmann SP, Culp RW. Bone-preserving arthroscopic options for treatment of thumb basilar joint arthritis. Hand Clin. 2011;27:355–359.PubMedGoogle Scholar
  4. 4.
    Badia A. Arthroscopic indications and technique for Artelon interposition arthroplasty of the thumb trapeziometacarpal joint. Tech Hand Up Extrem Surg. 2008;12:236–241.PubMedCrossRefGoogle Scholar
  5. 5.
    Badia A, Riano F, Young LC. Bilateral arthroscopic tendon interposition arthroplasty of the thumb carpometacarpal joint in a patient with Ehlers-Danlos syndrome: a case report. J Hand Surg Am. 2005;30:673–676.PubMedCrossRefGoogle Scholar
  6. 6.
    Berger RA. A technique for arthroscopic evaluation of the first carpometacarpal joint. J Hand Surg Am. 1997;22:1077–1080.PubMedCrossRefGoogle Scholar
  7. 7.
    Burton RI, Pellegrini VD Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am. 1986;11:324–332.PubMedCrossRefGoogle Scholar
  8. 8.
    Choung EW, Tan V. Foreign-body reaction to the Artelon CMC joint spacer: case report. J Hand Surg Am. 2008;33:1617–1620.PubMedCrossRefGoogle Scholar
  9. 9.
    Chu PJ, Lee HM, Chung LJ, Shih JT. Electrothermal treatment of thumb basal joint instability. Arthroscopy. 2009;25:290–295.PubMedCrossRefGoogle Scholar
  10. 10.
    Clarke S, Hagberg W, Kaufmann RA, Grand A, Wollstein R. Complications with the use of Artelon in thumb CMC joint arthritis. Hand (N Y). 2011;6:282–286.PubMedCentralCrossRefGoogle Scholar
  11. 11.
    Cobb TK, Berner SH, Badia A. New frontiers in hand arthroscopy. Hand Clin. 2011;27:383–394.PubMedCrossRefGoogle Scholar
  12. 12.
    Culp RW, Rekant MS. The role of arthroscopy in evaluating and treating trapeziometacarpal disease. Hand Clin. 2001;17:315–319, x–xi.PubMedGoogle Scholar
  13. 13.
    Dell PC, Brushart TM, Smith RJ. Treatment of trapeziometacarpal arthritis: results of resection arthroplasty. J Hand Surg Am. 1978;3:243–249.PubMedCrossRefGoogle Scholar
  14. 14.
    Diaconu M, Mathoulin C, Facca S, Liverneaux P. Arthroscopic interposition arthroplasty of the trapeziometacarpal joint. Chir Main. 2011;30:282–287.PubMedCrossRefGoogle Scholar
  15. 15.
    Earp BE, Leung AC, Blazar PE, Simmons BP. Arthroscopic hemitrapeziectomy with tendon interposition for arthritis at the first carpometacarpal joint. Tech Hand Up Extrem Surg. 2008;12:38–42.PubMedCrossRefGoogle Scholar
  16. 16.
    Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55:1655–1666.PubMedGoogle Scholar
  17. 17.
    Edwards SG, Ramsey PN. Prospective outcomes of stage III thumb carpometacarpal arthritis treated with arthroscopic hemitrapeziectomy and thermal capsular modification without interposition. J Hand Surg Am. 2010;35:566–571.PubMedCrossRefGoogle Scholar
  18. 18.
    Furia JP. Arthroscopic débridement and synovectomy for treating basal joint arthritis. Arthroscopy. 2010;26:34–40.PubMedCrossRefGoogle Scholar
  19. 19.
    Glickel SZ, Kornstein AN, Eaton RG. Long-term follow-up of trapeziometacarpal arthroplasty with coexisting scaphotrapezial disease. J Hand Surg Am. 1992;17:612–620.PubMedCrossRefGoogle Scholar
  20. 20.
    Greenberg JA, Mosher JF Jr, Fatti JF. X-ray changes after expanded polytetrafluoroethylene (Gore-Tex) interpositional arthroplasty. J Hand Surg Am. 1997;22:658–663.PubMedCrossRefGoogle Scholar
  21. 21.
    Hofmeister EP, Leak RS, Culp RW, Osterman AL. Arthroscopic hemitrapeziectomy for first carpometacarpal arthritis: results at 7-year follow-up. Hand (N Y). 2009;4:24–28.PubMedCentralCrossRefGoogle Scholar
  22. 22.
    Jones NF, Maser BM. Treatment of arthritis of the trapeziometacarpal joint with trapeziectomy and hematoma arthroplasty. Hand Clin. 2001;17:237–243.PubMedGoogle Scholar
  23. 23.
    Jorheim M, Isaxon I, Flondell M, Kalen P, Atroshi I. Short-term outcomes of trapeziometacarpal Artelon implant compared with tendon suspension interposition arthroplasty for osteoarthritis: a matched cohort study. J Hand Surg Am. 2009;34:1381–1387.PubMedCrossRefGoogle Scholar
  24. 24.
    Kuhns CA, Emerson ET, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: a prospective, single-surgeon study including outcomes measures. J Hand Surg Am. 2003;28:381–389.PubMedCrossRefGoogle Scholar
  25. 25.
    Landstrom JT. Radial portal tendon harvest and interposition in arthroscopic treatment of thumb basilar joint osteoarthritis. J Hand Surg Am. 2008;33:442–445.PubMedCrossRefGoogle Scholar
  26. 26.
    Martou G, Veltri K, Thoma A. Surgical treatment of osteoarthritis of the carpometacarpal joint of the thumb: a systematic review. Plast Reconstr Surg. 2004;114:421–432.PubMedCrossRefGoogle Scholar
  27. 27.
    Menon J. Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis of the thumb. J Hand Surg Br. 1995;20:700–706.PubMedCrossRefGoogle Scholar
  28. 28.
    Menon J. Arthroscopic management of trapeziometacarpal joint arthritis of the thumb. Arthroscopy. 1996;12:581–587.PubMedCrossRefGoogle Scholar
  29. 29.
    Muermans S, Coenen L. Interpositional arthroplasty with Gore-Tex, Marlex or tendon for osteoarthritis of the trapeziometacarpal joint. A retrospective comparative study. J Hand Surg Br. 1998;23:64–68.PubMedCrossRefGoogle Scholar
  30. 30.
    Nicholas RM, Calderwood JW. De la Caffiniere arthroplasty for basal thumb joint osteoarthritis. J Bone Joint Surg Br. 1992;74:309–312.PubMedGoogle Scholar
  31. 31.
    Nilsson A, Liljensten E, Bergstrom C, Sollerman C. Results from a degradable TMC joint Spacer (Artelon) compared with tendon arthroplasty. J Hand Surg Am. 2005;30:380–389.PubMedCrossRefGoogle Scholar
  32. 32.
    Nilsson A, Wiig M, Alnehill H, Berggren M, Bjornum S, Geijer M, Kopylov P, Sollerman C. The Artelon CMC spacer compared with tendon interposition arthroplasty. Acta Orthop. 2010;81:237–244.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Noland SS, Saber S, Endress R, Hentz VR. The scaphotrapezial joint after partial trapeziectomy for trapeziometacarpal joint arthritis: long-term follow-up. J Hand Surg Am. 2012;37:1125–1129.PubMedCrossRefGoogle Scholar
  34. 34.
    Pegoli L, Parolo C, Ogawa T, Toh S, Pajardi G. Arthroscopic evaluation and treatment by tendon interpositional arthroplasty of first carpometacarpal joint arthritis. Hand Surg. 2007;12:35–39.PubMedCrossRefGoogle Scholar
  35. 35.
    Pellegrini VD Jr. Osteoarthritis at the base of the thumb. Orthop Clin North Am. 1992;23:83–102.PubMedGoogle Scholar
  36. 36.
    Rizzo M, Moran SL, Shin AY. Long-term outcomes of trapeziometacarpal arthrodesis in the management of trapeziometacarpal arthritis. J Hand Surg Am. 2009;34:20–26.PubMedCrossRefGoogle Scholar
  37. 37.
    Robinson PM, Muir LT. Foreign body reaction associated with Artelon: report of three cases. J Hand Surg Am. 2011;36:116–120.PubMedCrossRefGoogle Scholar
  38. 38.
    Thomsen NO, Jensen CH, Nygaard H. Weilby-Burton arthroplasty of the trapeziometacarpal joint of the thumb. Scand J Plast Reconstr Surg Hand Surg. 2000;34:253–256.PubMedCrossRefGoogle Scholar
  39. 39.
    Tropet Y, Gallinet D, Lepage D, Gasse N, Obert L. Treatment of trapeziometacarpal osteoarthritis by partial trapeziectomy and costal cartilage autograft. A review of 100 cases. Chir Main. 2012;31:145–151.PubMedCrossRefGoogle Scholar
  40. 40.
    Wajon A, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev. 2009;4:CD004631.PubMedGoogle Scholar
  41. 41.
    Yao J, Park MJ. Early treatment of degenerative arthritis of the thumb carpometacarpal joint. Hand Clin. 2008;24:251–261, v–vi.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of MinnesotaMinneapolisUSA

Personalised recommendations