Thumb Carpometacarpal Joint Resurfacing With Autologous Ear Cartilage

Update on Thumb Basal Joint Arthritis Surgery

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Comprehend anatomy and biomechanics of the normal and arthritic trapeziometacarpal joint. 2. Evaluate best evidence for diagnosis and for operative and nonoperative treatment of thumb osteoarthritis. 3. Understand treatment pitfalls of basilar joint arthritis and complication avoidance.

SUMMARY

Articular and ligamentous anatomy of the trapeziometacarpal joint enables complex motions. Disability from arthritis, common at the trapeziometacarpal joint, is debilitating. Furthering the understanding of how trapeziometacarpal arthritis develops can improve treatment. The authors provide current best evidence for diagnosis and treatment of basilar joint arthritis. Pitfalls in treatment are discussed.

Combination Therapy Involving Ear Cartilage Transfer and Suture-Button Suspension Arthroplasty for Symptomatic Thumb Carpometacarpal Joint Arthritis

We describe the short-term outcomes of combination therapy involving ear cartilage transfer and suture-button suspension arthroplasty for the treatment of symptomatic thumb carpometacarpal joint arthritis. The concept is to reduce joint arthritis by separate independent approaches, which are renewing the damaged joint surface of the trapezium and first metacarpal bone suspension. Autologous ear cartilage is a desirable material for joint resurfacing arthroplasty without postoperative synovitis or infection, and it is expected to prevent bone impingement or recurrent joint arthritis when postoperative suture-button slack or failure unfortunately occurs.

Evidence-Based Medicine: Thumb Basal Joint Arthritis

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Assess the patient's history, clinical examination, and radiographic findings to diagnose and stage basilar joint arthritis. 2. Recall the cause and epidemiology of the condition. 3. Formulate a management plan including nonoperative management, and evaluate the candidacy for surgical treatment. 4. Understand the rationale for the various surgical options available (including rehabilitation), their potential complications, and the evidence related to outcomes.

SUMMARY

This article has been prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is designed for clinicians to analyze and structure their care of a patient with arthritis of the trapeziometacarpal joint.

Chondrogenic capability of osteoarthritic chondrocytes from the trapeziometacarpal and hip joints

Osteoarthritis is the most common degenerative disease of joints like the hip and the trapeziometacarpal joint (rhizarthrosis). In this in vitro study, we compared the chondrogenesis of chondrocytes derived from the trapezium and the femoral head cartilage of osteoarthritic patients to have a deeper insight on trapezium chondrocyte behavior as autologous cell source for the repair of cartilage lesions in rhizarthrosis. Chondrocytes collected from trapezium and femoral head articular cartilage were cultured in pellets and analyzed for chondrogenic differentiation, cell proliferation, glycosaminoglycan production, gene expression of chondrogenic and fibrous markers, histological and immunohistochemical analyses. Our results showed a higher cartilaginous matrix deposition and a lower fibrocartilaginous phenotype of the femoral chondrocytes with respect to the trapezium chondrocytes assessed by a higher absolute glycosaminoglycan and type II collagen production, thus demonstrating a superior chondrogenic potential of the femoral with respect to the trapezium chondrocytes. The differences in chondrogenic potential between trapezium and femoral head chondrocytes confirmed a lower regenerative capability in the trapezium than in the femoral head cartilage due to the different environment and loading acting on these joints that affects the metabolism of the resident cells. This could represent a limitation to apply the cell therapy for rhizoarthrosis.