Total first carpometacarpal joint arthroplasty for severe osteoarthritis in active workers
Nicolas Dreant, MD; Marie Anne Poumellec, MD
Pole Urgence Main, Nice, France
Purpose: Osteoarthritis of the thumb basal joint is a common and disabling condition that frequently affects workers in activity. If resection suspension arthroplasty of the trapezium still represents the golden standard in the treatment, joint replacement has been an effective solution of this condition. The purpose of this work is to present the outcome of a total trapeziometacarpal implant in the treatment of advanced stages of first carpometacarpal joint osteoarthritis in an active working population.
Methods: Total arthroplasty of the trapeziometacarpal joint was performed on 58 thumbs in 48 active workers (37 women and 11 men) with a mean age of 55 years, to treat advanced osteoarthritis (Eaton and Littler stages III and early IV) between january 2014 and december 2018. Indications for surgery after failure of conservative treatment were severe pain, loss of pinch strength, and diminished thumb motion that limited professional activities. Two different new generation double mobility trapeziometacarpal joint prostheses were used in this series. The average follow-up time was 5.3 years (3-8).
Results: At the final follow-up evaluation, the mean pain score was 1 (8 preoperatively) the Kapandji score averaged 10 and pinch strength averaged 7 kg (90% of nonaffected side). Final functional results were good: the mean Quick Disabilities of the Arm, Shoulder and Hand Questionnaire score was 12, and the mean Michigan Hand Outcomes score was 87%. Radiographic studies at the final follow-up evaluations showed no implant loosening. One patient, heavy worker, has been reoperated for PE breakage, two patients for De Quervain�s tenosynovitis and a patient presented with a subcutaneous rupture of the FCR tendon with no need for another surgery.
Conclusions: Total joint arthroplasty of the thumb CMC joint with a dual mobility prosthesis appears to be a good solution in our series. It has proven to be efficacious with improved motion, strength, and pain relief in the medium term follow-up. We currently recommend this technique for the treatment of stage III and early stage IV osteoarthritis of the first carpometacarpal joint in active workers with medium activity demands.
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