Orthopedics-Online

Surgery for a thumb saddle joint osteoarthritis

introduction

In terms of Thumb saddle joint osteoarthritis there are different forms of therapy that can be used. In principle, a distinction is made between the

conservative and
operative therapy

Which form of therapy should be considered individually depends on the degree of the disease and can differ from patient to patient. Often, conservative therapy methods are usually started and surgery is usually only considered if the patient does not respond or only slightly responds to conservative therapy.

Operative therapy

More advanced forms of saddle joint arthrosis often defy conservative therapy. If the pain persists or even increases despite such a form of therapy, surgical therapy should be considered.

There are now several possible approaches in the area of surgical therapy. Thus, surgical therapy nowadays does not automatically mean that the joint is stiffened. This is now only the exception.

Which type of surgical treatment is suitable for you cannot be decided across the board. Every approach - whether conservative or operative - has to be weighed up individually.

In principle, the following types of surgical therapy are available:

The Resection arthroplasty
The Resection of the trapezium

On the Trapezium, the large polygonal bone, is the 1st ray (= thumb). The wear and tear develops around this trapezium, the so-called Thumb saddle joint osteoarthritis.

To put it simply, this surgical procedure implies the opening of the joint capsule and the removal of the trapezium and associated with it the removal of any signs of wear. Finally, the joint capsule is carefully closed again.

Resection is a relatively simple procedure that maintains mobility as such. The disadvantage is that the thumb beam is shortened considerably, which ultimately causes the muscles to lose strength. As a rule, however, the loss of strength is significantly less than the loss of strength that existed before the operation due to illness. Perhaps one should better avoid a loss of strength in relation to the condition talk before the disease!

Appointment with a hand specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me at:

Lumedis - orthopedics
Kaiserstrasse 14
60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, appointments can only be made with private health insurers. I ask for understanding!
Further information about myself can be found at Lumedis - Dr. Nicolas Gumpert

Resection of the trapezium with an interposition

The resection of the trapezium in combination with an interposition is also known as an Epping plastic.

This surgical procedure basically consists of two sub-steps, the first sub-step being the same as resection of the trapezium (a).

In addition, however, a section in the form of a split-off tendon strip is removed from the body's own tendon tissue, which is inserted into the cavity created by the removal of the trapezium by pulling it through a drill hole on the thumb. With this insertion one would like to prevent the 1st ray (= thumb) from sinking into the cavity.

The advantage compared to the "simple" resection of the trapezium is that the thumb beam is somewhat less shortened. However, additional tendon tissue must be removed and this can also reduce the force.

An alternative to interposing your own tendon tissue is to implant an implant. This implant consists of a mixture of silicone and rubber and is known as the so-called "Swanson implant" (Silastic spacer). While the two surgical methods above often shorten the thumb beam and reduce force transmission, this can be avoided with the implant.

The disadvantage of the implant is currently still in the nature of the material. Science has not yet fully succeeded in developing materials that do not show any wear. Hence that too "Swanson implant" be affected by material abrasion. Breaks and the associated replacement operations must also be taken into account. Likewise the occurrence of synovitis (= inflammation of the mucous membrane) and / or cystic changes in the area of the bone. Finally, subluxation of the implant is also possible.

Arthrodesis of the saddle joint

Under one Arthrodesis one understands one Joint stiffening. In general, arthrodesis of the saddle joint should only be carried out if it is ensured that the metacarpophalangeal joint is unchanged and without restrictions. This is important because this joint has to take over evasive movements as a result of the stiffening of the saddle joint and is therefore more demanding. The disadvantage of this operation is in particular that the thumb is considerably restricted in its mobility.

The total endoprosthetic replacement of the thumb saddle joint

There are different models that allow the endoprosthetic replacement of the thumb saddle joint. Before using an endoprosthesis, it should be ensured that other joints of the hand do not show any changes (osteoarthritis).

The use of foreign material can always require a replacement operation, but the operation goal (freedom from pain) is usually achieved more quickly by using a prosthesis.

Operational risks

Every operation is associated with risks. Before the operation, you will be individually advised of possible risks. In addition to the general risks, there are always individual risks that are related to your current physical condition. For this reason, the operational risks listed below are of a general nature and are only intended to serve as a guide. The list of operational risks does not claim to be complete!

Since the hand has many cutaneous nerves compared to other areas of the body, cutaneous nerves can be cut through the surgical skin opening. Under certain circumstances, this can result in permanent loss of feeling on the thumb and local pain at the injury site.
Infections or disorders of wound healing can generally never be ruled out during operations. If there is a serious infection, the joint may have to be surgically opened again and the infection treated.
Fine circulatory disorders of the hand occur less often, but can seriously affect the ability of the hand to move. As a rule, the circulatory disorders are accompanied by pain and swelling of the skin.

Aftercare

As a rule, the patient receives a splint after the operation (= postoperative) for about 4 weeks. All joints are freely movable within this rail.

After the immobilization, the operated thumb is slowly reintegrated into everyday life. This means that for a period of another 4 to 8 weeks, the performance cannot be fully restored. All attempts to get used to and integrate the thumb into everyday life must be carried out carefully. If pain occurs, this is usually always a sign of excessive demands. Accordingly, the occurrence of pain or swelling after surgery implies an immediate reduction in stress!

Read more here: Thumb brace

As a rule, reactivating the thumb takes place without stress and as independently as possible. The attending physician or the attending physiotherapist will show you the appropriate exercises. As a rule, physiotherapy / physiotherapy is only added if the patient does not stick to the agreed movement exercises.

Whether the reactivation is carried out on your own or with the help of physiotherapy / physiotherapy is decided according to the individual healing process.

However, should swelling occur after surgery, lymphatic drainage or occupational therapy may prove to be useful.