Introduction
With regard to arthrosis of the thumb saddle joint, there are various forms of therapy that can be applied. In principle, a distinction is made between Which form of therapy should be considered individually depends on the degree of the disease and can vary from patient to patient. In many cases, conservative therapy methods are usually started and surgery is usually only considered if the patient does not respond to conservative therapy or only responds slightly to it. – conservative and
- Surgical therapy
The surgical therapy
More advanced forms of thumb 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. In the meantime, there are also several possible approaches in the field of surgical therapy.
Thus, surgical therapy today does not automatically mean that the joint is stiffened. This is now only the exception. It is not possible to make a blanket decision about which form of surgical therapy is appropriate for you.
Each procedure – whether conservative or surgical – must be individually considered. In principle, the following operative forms of therapy are available: The 1st ray (= thumb) sits on the os trapezium, the large polygonal bone. Wear and tear develops around this os trapezium, the so-called thumb saddle joint arthrosis.
- The resection arthroplasty
- The resection of the trapezium
In simple terms, this surgical procedure implies the opening of the joint capsule and the removal of the trapezium, and thus the removal of any signs of wear. Finally, the joint capsule is carefully closed again. Resection is a relatively simple procedure that preserves mobility as such.
The disadvantage is that the thumb ray is considerably shortened, 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 was present prior to the operation due to illness. It is perhaps better to speak of a loss of strength in relation to the condition before the illness!
The resection of the trapezium in combination with an interposition is also known in specialist circles as Epping plasty. In principle, this surgical procedure consists of two sub-steps, whereby the first sub-step is similar to the resection of the trapezium (a). In addition, however, a section in the form of a split 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 in the thumb.
The aim of this insertion is to prevent the 1st ray (= thumb) from sinking into the cavity. The advantage in comparison to the “simple” resection of the trapezium is that a slightly smaller shortening of the thumb beam is achieved. However, additional tendon tissue must be removed and a reduction in strength can also occur here.
An alternative to the interposition of your own tendon tissue is to place an implant. This implant consists of a silicone-rubber mixture and is called a so-called “Swanson implant” (Silastik-Spacer). While the two upper surgical methods often show a shortening of the thumb beam and a reduced transmission of force, this can be avoided by the implant.
However, the disadvantage of the implant is currently still the nature of the material. Science has not yet fully succeeded in developing materials that do not show any signs of abrasion. Therefore, the “Swanson implant” can also be affected by material abrasion.
Fractures and 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 bone area. Finally, a subluxation of the implant is also possible.
An arthrodesis is a stiffening of the joint. In general, arthrodeses of the saddle joint should only be performed if it is ensured that the metacarpo-phalangeal joint is unchanged and without restrictions. This is important, since this joint has to take over evasive movements due to the stiffening of the saddle joint and is therefore more demanding.
The main disadvantage of this operation is that the thumb is considerably restricted in its mobility. There are various 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 (arthrosis).
The use of foreign material may always require a replacement operation, however, the use of a prosthesis usually achieves the surgical goal (freedom from pain) more quickly. 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 related to your current physical condition. For this reason, the surgical risks listed below are of a general nature and should only serve as a guide. The list of surgical risks does not claim to be complete in any way!
Infections or disturbances of wound healing can generally never be ruled out during operations. If there is a serious infection, the joint may have to be opened again surgically and the infection treated. – Since the hand has many skin nerves compared to other parts of the body, skin nerves can be cut through the surgical skin opening.
This may result in a permanent loss of sensation in the thumb and localised pain at the site of the injury. – Infections or disturbances in wound healing can generally never be ruled out during operations. If there is a serious infection, the joint may have to be opened again surgically and the infection treated. – Disorders of fine blood circulation in the hand occur less frequently, but can have a serious effect on the hand’s ability to move. Circulatory disorders are usually accompanied by pain and swelling of the skin.
