Thumb Carpometacarpal Osteoarthritis: New insights & Treatment opportunities

Osteoarthritis of the basal thumb joint is part of normal human aging: everyone gets it if we live long enough. Thumb pain can cause reduced pinch strength and impaired hand capability such as difficulty opening jars or turning a key. Symptom intensity does not correlate with the severity of basal thumb osteoarthritis on radiographs. Acceptance and adaptation in daily life are the primary treatment goals. This can often be achieved with splints and analgesics; surgery is not necessary. Notwithstanding, numerous surgical options are available but there is no consensus about which surgical treatment is most effective. The aim of this thesis was to explore patients’ and surgeons’ perspectives on basal thumb osteoarthritis, and discuss outcomes of surgical treatment by pyrocarbon disc and joint distraction.

CONCLUSIONS

1. Online information on CMC1 osteoarthritis is often difficult to read and biased in
favor of a particular treatment. Clinicians should be prepared to gently reorient
any misconceptions about the etiology (it is not an acute injury but part of human
aging) and on the effectiveness of treatment options (adaptation is the foundation
of healthcare, a surgical “quick fix” does not exist).

2. There is surgeon-to-surgeon variation in testing (obtaining radiographs) and
treatment (injection and surgery) for CMC1 osteoarthritis. Surgeons seem to base
their recommendations for operative treatment largely on subjective factors.
Shared decision making and decision aids may help ensure that a treatment
choice is not based on misconceptions or surgeon preferences, and instead
reflects the personal values of the patient.

3. If implant displacement occurs after pyrocarbon disc interposition arthroplasty
for CMC1 osteoarthritis, most people do not experience pain or limitation in their
daily activities. Revision surgery is performed in about 1 out of 10 people mainly
because of dissatisfaction with pain alleviation (which does not correspond
with radiographic findings). Given this lack of correspondence, the role of the
pyrocarbon interposition is open to debate, and revision surgery is not needed
based on the radiographic findings alone.

4. Temporary joint distraction is a technically feasible treatment for people with
CMC1 osteoarthritis. Application of this technique was associated with a second
surgery for arthroplasty among one of 20 patients within two years. Larger,
randomized, comparative studies are needed to be sure that this distraction
alleviates symptoms better than simulated distraction and to assess the exact place
of joint distraction in treatment of CMC1 osteoarthritis.