Treatment of thumb carpometacarpal osteoarthritis; quo vadis?

Abstract

The unique prehensile ability of the human hand is largely due to the biomechanical function of its complex first carpometacarpal (CMC1) joint. This makes the thumb the most important digit of the hand. The unique demands placed on the thumb regarding mobility, stability and transmission of force make it prone for degenerative changes. Thumb CMC joint osteoarthritis (OA) is a common and debilitating problem for the patient and a challenge to manage for primary care providers, hand therapists and hand surgeons. In this thesis treatment principles and options are discussed and evaluated to provide insight in the current knowledge of this rapidly evolving field. Conservative treatment can consist of patient education in joint protection, an intra-articular injection or an orthosis. If these measurements are insufficient, an operative intervention can be performed. Although a trapeziectomy has been considered the gold standard treatment, this treatment will not yield the best results in all patients. Other treatment options that could be considered are partial trapeziectomy with interposition of fascia lata allograft, implantation of a total joint prosthesis, and joint distraction. Implantation of a polyethylene mesh implant is not recommended because of the possible foreign body reaction. Choosing the optimal treatment for each individual patient with CMC1 OA is difficult and remains a challenge due to the variety of treatment options given my modern day medicine. Although trapeziectomy is considered the gold standard treatment, many subgroups of patients might be more eligible for other non-surgical or surgical interventions. Better tools to adequately select the right patient for each operative technique are essential and needed: treatment must be patient-tailored. Ultimately, our goal is to develop a clear, well defined and evidence based treatment strategy for each individual patient who presents with CMC1 OA. This requires a large amount of prospective research and data collection in an organised and standardised fashion. Only by sharing experience, knowledge and research efforts, we can attempt to obtain good guidelines to provide our patients with the best available care.