Basal thumb osteoarthritis

What is basal thumb osteoarthritis?

Basal thumb osteoarthritis is a common problem, particularly in women in their fifties, where it is usually bilateral.
Sometimes osteoarthritis is the result of a fracture, rheumatism or infection, but more often the exact cause of osteoarthritis is not known.

What are the symptoms of basal thumb osteoarthritis?

The usual symptom is pain, especially when it occurs during everyday activities such as turning a key or handling small objects between the thumb and index finger.
Gradually the joint deteriorates and subluxates or dislocates, and a characteristic deformation appears at the base of the thumb.2

What is the treatment of basal thumb osteoarthritis?

Initially, treatment includes rest and avoiding painful activities.

Anti-inflammatory, a thumb webspace
night splint and optionally steroid injection(s) must be attempted.
If correct conservative treatment for six months to a year is not efficient, surgery should be considered.

What are the surgical procedures?

The procedure always consists in removing and replacing the arthritic painful joint surfaces.

All these procedures are usually performed on a day surgery basis or overnight hospitalisation, under local anaesthesia of the upper limb.

There are different options to consider according to the extent of osteoarthritis, the extent of dislocation, patient age and occupation.

Tendon interposition

with complete excision of the trapezium is a reliable technique that provides long-term result. Reoperation is extremely rare. The drawbacks of this operation are a 3 to 6 months postoperative recovery period, and incomplete recovery of strength and mobility.

 

Total joint replacement with a ball-and –socket arthroplasty

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overcomes these drawbacks. Function is recovered after a few weeks and the length of the thumb can be accurately restored. The drawbacks of this technique are mainly infection – as for any artificial prosthesis, and long-term wear or loosening of the prosthesis.

Pyrocarbon interposition is a new concept that may prove efficient but still lacks sufficient follow-up .Trapeziometacarpal fusion is rarely performed nowadays and must be limited to very special cases.

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What are the specific risks of surgery?

You will be given an informed consent form before surgery. We explain to you as objectively and thoroughly as possible the principles of intervention, as well as the risks of complications.
You will also be informed regarding the symptoms to watch out for after surgery.
This preoperative risk information will allow you to react quickly in case of complications. Complications do not usually leave any residual or permanent disability if treated in time.

After surgery:

You will leave the clinic the day after surgery at the latest, with a bandage to avoid pain and promote healing.
The first review in clinic with your surgeon is usually 8 days after surgery to check the healing.
Rehabilitation is not always necessary.
Complete recovery may require 3weeks to 6 months according to the surgical procedure.