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Minerva Orthopedics 2022 June;73(3):253-8

DOI: 10.23736/S2784-8469.21.04120-1


language: English

Reduction arthroplasty for surgical treatment of thumb carpometacarpal joint arthritis in 419 patients: results up to 9-year follow-up in a multicentric study

Cesare BADOINO 1, Paolo PANCIERA 2, Stefano TOGNON 3, Michele D. LOMBARDO 4, 5, Simona ODELLA 5 , Pierluigi TOS 5

1 Villa Montallegro Hospital, Genoa, Italy; 2 Villa Salus Hospital, Mestre, Venice, Italy; 3 Salus Private Hospital, Ferrara, Italy; 4 Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy; 5 Unit of Hand and Reconstructive Microsurgery, ASST Gaetano Pini-CTO, Milan, Italy

BACKGROUND: Thumb carpometacarpal (T-CMC) arthritis occurs up to 25% in female and up to 8% in male population and represents the most frequent arthritis in the hand. Along all history of hand surgery, many different treatments have been proposed to address the T-CMC arthritis. The purpose of this paper was to describe an innovative, simple, fast, nonexpensive and reproductible surgical technique, and the reduction arthroplasty (RA) for moderate to severe T-CMC arthritis (up to a stage 3 according to Eaton’s Classification). The secondary aim of the study was to assess the clinical and functional outcome.
METHODS: This multicentric study has been carried out by 4 operative units. From 1987 to 2018, 419 patients operated with the reduction arthroplasty technique were evaluated. The results of Quick-Disability of the Arm, Shoulder and Hand (Quick-Dash), Patient Rated Wrist/Hand Evaluation (PRWHE) questionnaires were also recorded. Functional tests such as Jamar, key pinch and opposition pinch were registered. Radiographic studies were also carried out. Ultimately, specifical clinical tests (adduction, extension), Numeric Rating Scale (NRS) and Kapandji Test were administered.
RESULTS: All reviewed patients returned to their activities and/or work within an average time of 9 weeks from the operation (range: 3-28; SD±2 weeks). In 25% of cases there was a very rapid cessation of pain, already in the first postoperative period. In the other patients, it took a longer period, but in any case, not beyond 15 weeks. Mean preoperative NRS=6.2 (SD±2), postoperative at rest 0.7 (SD±0.5) and during activity 1.8 (SD±1).
CONCLUSIONS: The RA technique is easily reproducible, the learning curve is fast, and the complication rate is low, this surgical technique gives good residual mobility, grip strength comparable to the contralateral limb and significant reduction of pain; moreover, the rehabilitation could often be self-administered by the patient. The average surgical time is about 30 minutes. In addition, recently the wide-awake local anesthesia no tourniquet (WALANT) technique was introduced with all its known benefits.

KEY WORDS: Arthritis; Thumb; Arthroplasty

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