thumb carpo-metacarpal osteoarthritis. júlio andré, fernando cruz, mªjosémaio

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 !