Introduction and purpose: Rhizarthrosis of the thumb is the most common form of osteoarthritis of the hand. In some cases it courses with intense pain and severe functional limitation of the thumb or the entire hand. The purpose of this study is to compare the results of treating rhizarthrosis with a total ARPE trapezio-metacarpal prosthesis and trapezectomy, whether or not associated with tendon interposition and ligament repair. Materials and methods: A retrospective comparative study in which we reviewed cases of rhizarthrosis treated surgically in our hospital between 1994 and 2004. We found 75 cases, of which 28 were treated with resection arthroplasty (group A), 32 with ARPE prosthesis (group B) and 15 with bone fusion (not included in this study). The mean age was 58.85 for group A and 63.16 for group B. Mean follow-up time was 39.5 months. We used the DASH questionnaire for the subjective clinical examination and the Jamar dynamometer for the objective examination. For radiological assessment we used the Eaton classification and Walch radiological criteria. Results: We analysed the results using SPSS statistical software and found no significant differences between the two groups, although the subjective assessment showed better results in terms of mobility and pain remission in group B and strength in group A. Conclusions: The aim of surgical treatment of rhizarthrosis is to achieve a stable, pain-free thumb. Several procedures are available, the success of which depends on correct indication and meticulous surgical technique

Pain free function of the thumb carpometacarpal (CMC) joint is essential for manual work. Osteoarthrithis of the thumb saddle joint is very common. Among different conservative and operative treatment options (ergotherapy, intraarticular infiltration, ligament reconstruction, resectionarthroplasty, arthrodesis, spacer), the implantation of a prosthesis is an alternative. This prospective study reports short time results of the uncemented hydroxilapatite coated Ivory prosthesis. The mean follow up time of the 21 patients was 12.1 months (range 6 to 18 months) and the mean age 57.2 years. The patients suffered from osteoarthritis of the thumb saddle joint stage II–III according to Eaton Littler. We evaluated the Disabilities of the Arm, Shoulder and Hand Score (DASH), pain with the visual analogue scale (VAS), clinical (abduction, flexion, strength) and radiological outcome.

The clinical results showed excellent pain relief with an improvement of the VAS from 7.3 preoperative to 0.8 postoperative (p< 0.05) and a decline of the DASH score from 42.9 to 6.05 points (p< 0.5). We measured an abduction with a mean of 47.5° and a flexion with a mean of 43.2°. The power of the fist grip was in mean 31.3 kg, of the key grip 6.4 kg. Radiological there were no signs of implant loosening. As complications occurred one posttraumatic trapezium fracture with luxation and one tendovaginits De Quervain.

The advantage of a total replacement of the CMC I joint, compared to the standard resection arthroplasty, is faster rehabilitation and preservation of the length of the thumb and so better strength. Our results are encouraging, but we have to wait for long time results mainly concerning implant loosening. In the case of the trapezium fracture with luxation we could remove the prosthesis and performed a resectionarthroplasty.

Aims

In the treatment of basal thumb osteoarthritis (OA), intra-articular autologous fat transplantation has become of great interest within recent years as a minimally invasive and effective alternative to surgical intervention with regard to pain reduction. This study aims to assess its long-term effectiveness.