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Winter R, Tuca AC, Justich I, Tschauner S, Friedl H, Girsch W, Lebo P, Zrim R, Lumenta DB, Kamolz LP. Minimally Invasive Treatment of Trapeziometacarpal Osteoarthritis: Results of a Blinded Randomized Controlled Trial. Plast Reconstr Surg 2023; 152:1277-1285. [PMID: 37039525 DOI: 10.1097/prs.0000000000010516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Surgical therapy for widespread first carpometacarpal (CMC1) arthritis permanently alters the physiologic anatomy of the hand. The injection of autologous substances into the thumb saddle joint could achieve temporary pain relief and delay surgical indications. This trial aimed to compare the pain-reducing effects of autologous fat and/or platelet-rich plasma (PRP) with saline 0.9% in the infiltration therapy of carpometacarpal arthritis of the thumb (CMC1 arthritis). METHODS A blinded, randomized controlled trial was conducted. Ninety-five patients with CMC1 arthritis were included in the study. The mean follow-up period was 2 years. Participants were injected with 1.5 mL of autologous fat, PRP, autologous fat and PRP, or 0.9% saline solution into the CMC1 joint, depending on the group allocation. The primary outcome of this study was the evaluation of pain reduction in each treatment group. RESULTS The combination of fat and PRP was the only treatment that resulted in a significantly greater reduction in pain compared with 0.9% saline ( P = 0.003). Similarly, fat and PRP in combination was the only therapy group to achieve clinically relevant Quick Disabilities of Arm, Shoulder, and Hand score reduction, and the only group that showed a significantly better Medical Outcomes Study 36-Item Short-Form Health Survey score than 0.9% saline ( P = 0.016). No major complications were noted. CONCLUSIONS In addition to pain reduction, the combination of autologous fat and PRP yields a relevant improvement in hand function and a corresponding improvement in quality of life. This treatment seems to be a viable and safe alternative to short-acting glucocorticoids. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Raimund Winter
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery; Research Unit for Tissue Regeneration, Repair, and Reconstruction
| | - Alexandru-Cristian Tuca
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery; Research Unit for Tissue Regeneration, Repair, and Reconstruction
| | - Ivo Justich
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery; Research Unit for Tissue Regeneration, Repair, and Reconstruction
| | - Sebastian Tschauner
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz
| | - Herwig Friedl
- Institute of Statistics, Graz University of Technology
| | - Werner Girsch
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery; Research Unit for Tissue Regeneration, Repair, and Reconstruction
| | - Patricia Lebo
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery; Research Unit for Tissue Regeneration, Repair, and Reconstruction
| | - Robert Zrim
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery; Research Unit for Tissue Regeneration, Repair, and Reconstruction
| | - David Benjamin Lumenta
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery; Research Unit for Tissue Regeneration, Repair, and Reconstruction
| | - Lars-P Kamolz
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery; Research Unit for Tissue Regeneration, Repair, and Reconstruction
- Cooperative Centre for Regenerative Medicine, Joanneum Research GmbH
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Weninger P, Feichtinger X, Steffel C, Kerschbaumer C, Duscher D. Arthroscopy with Lipoaspirate and Plasma Infiltration Using Adipose-Derived Stem Cells Plus Platelet-Rich Plasma: Harvesting and Injection for Arthroscopic Treatment of Cartilage Defects of the Knee. Arthrosc Tech 2023; 12:e2265-e2271. [PMID: 38196888 PMCID: PMC10773146 DOI: 10.1016/j.eats.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/30/2023] [Indexed: 01/11/2024] Open
Abstract
Osteoarthritis, predominantly of the knee, is a highly prevalent disease leading to pain, reduced quality of life, and significantly reduced ability to work. With autologous orthobiologic options, new regenerative treatment methods have emerged, offering an alternative to early surgical intervention. Supercharged Liparthroplasty combines arthroscopy with lipoaspirate and plasma infiltration of the joint. Lipoaspirate contains high levels of adipose-derived stem cells, which show chondroprotective and anti-inflammatory qualities. Intra-articular injection, combined with platelet-rich plasma administration for accelerated cartilage metabolism, thus provides an optional approach in osteoarthritis treatment. This article aims to provide in detail our regimen for Supercharged Liparthroplasty, including tissue harvesting and preparation of the injectables, therefore enabling physicians to adopt this point-of-care technique.
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Affiliation(s)
- Patrick Weninger
- Sports Medical Center, Vienna, Austria
- Academic Stem Cell Center Vienna, Vienna, Austria
| | | | - Caterina Steffel
- Sports Medical Center, Vienna, Austria
- Academic Stem Cell Center Vienna, Vienna, Austria
| | | | - Dominik Duscher
- The Face and Longevity Center Munich, Munich, Germany
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, Tübingen, Germany
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Hasiba-Pappas S, Kamolz LP, Luze H, Nischwitz SP, Lumenta DB, Winter R. Regenerative Therapies for Basal Thumb Arthritis-A Systematic Review. Int J Mol Sci 2023; 24:14909. [PMID: 37834357 PMCID: PMC10573355 DOI: 10.3390/ijms241914909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local steroid injections and/or surgery. Yet, therapeutic data on long-term improvement and even cartilage repair are scarce. This review aims to present the currently available literature on novel therapies for basal thumb arthritis, including platelet-rich plasma (PRP), fat grafting and phototherapy, and investigate their potential efficacy. The entire OVID database and PubMed were searched for studies containing the topics PRP injection, lipofilling, laser treatment and regenerative treatment for carpometacarpal arthritis. Seven studies on the effect of fat tissue on basal thumb arthritis were found. Four authors reported on PRP injections, one RCT examined a combinational treatment of PRP and fat grafting, another phototherapy for the thumb joint and one prospective trial on chondrocyte transplantation was found. Pain improvement and decreased impairment were reported in the majority of PRP and/or fat grafting studies as well as after chondrocyte implantation. Phototherapy did not significantly improve the condition. This review revealed that only limited data on regenerative therapies for carpometacarpal arthritis are currently available, yet PRP and lipofilling show promising results and merit further investigation.
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Affiliation(s)
- Sophie Hasiba-Pappas
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
| | - Lars-P. Kamolz
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
- COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research GmbH, Neue Stiftingtalstr. 2, A-8010 Graz, Austria
| | - Hanna Luze
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
| | - Sebastian P. Nischwitz
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
| | - David B. Lumenta
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
| | - Raimund Winter
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
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Kolbe K, Haffner I, Schierle K, Maier D, Geier B, Luber B, Bläker H, Wittekind C, Lordick F. Deviating HER2 test results in gastric cancer: analysis from the prospective multicenter VARIANZ study. J Cancer Res Clin Oncol 2023; 149:1319-1329. [PMID: 36030286 PMCID: PMC9984518 DOI: 10.1007/s00432-022-04208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The prospective multicenter VARIANZ study aimed to identify resistance biomarkers for HER2-targeted treatment in advanced gastric and esophago-gastric junction cancer (GC, EGJC). HER2 test deviations were found in 90 (22.3%) of 404 cases (central versus local testing) and were associated with negative impact on survival for trastuzumab-treated patients. Here, we investigated methodological and biological variables that may promote deviating HER2 test results. METHODS We analyzed HER2 testing procedures and participation in quality assurance programs of 105 participating local pathology laboratories. Furthermore, tumor localization and histological subtypes were compared between patients with centrally confirmed (central HER2 + /local HER2 + , n = 68) and unconfirmed HER2 status (central HER2 -/local HER2 + , n = 68). RESULTS For central HER2 testing, concordance between in situ hybridization (ISH) and immunohistochemistry (IHC) was 98.3%, with IHC sensitivity of 93.3% (84 IHC + of 90 ISH +), specificity of 99.5% (389 IHC- of 391 ISH-), and a positive diagnosis rate of 97.7%. Central confirmation of the local HER2 IHC scores were seen for the majority of locally HER2- IHC 0/1 (172/178; 96.6%), but less frequently for locally IHC3 + (57/124; 46.0%) cases. Deviation rate was not associated with IHC antibody platform used in the local pathology institute neither with participation in quality-assuring tests. Regarding tumor characteristics, deviating test results were more frequently found in GC vs. EGJC (69.1% vs. 39.7%; p = 0.001) and in Laurén diffuse vs. intestinal subtype (23.5% vs. 5.9%, p = 0.004). CONCLUSION Tumor localization and histological subtype have an impact on HER2 test deviation rates. Assessment of HER2 remains challenging for GC and EGJC.
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Affiliation(s)
- Katharina Kolbe
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Disease, Leipzig University Medical Center, University Cancer Center Leipzig (UCCL), Leipzig, Germany
| | - Ivonne Haffner
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Disease, Leipzig University Medical Center, University Cancer Center Leipzig (UCCL), Leipzig, Germany.
| | - Katrin Schierle
- Institute of Pathology, Heilbronn SLK-Kliniken GmbH, Heilbronn, Germany
| | | | | | - Birgit Luber
- Institute of Pathology, Technische Universität München, Munich, Germany
| | - Hendrik Bläker
- Department of Pathology, Leipzig University Medical Center, Leipzig, Germany
| | - Christian Wittekind
- Department of Pathology, Leipzig University Medical Center, Leipzig, Germany
| | - Florian Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Disease, Leipzig University Medical Center, University Cancer Center Leipzig (UCCL), Leipzig, Germany
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Winter R, Hasiba-Pappas SK, Tuca AC, Zrim R, Nischwitz S, Popp D, Lumenta DB, Girsch W, Kamolz LP. Autologous Fat and Platelet-Rich Plasma Injections in Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2023; 151:119-131. [PMID: 36219860 DOI: 10.1097/prs.0000000000009789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND For the treatment of carpometacarpal arthritis of the thumb, various therapies are used. Infiltration therapy with autologous substances such as platelet-rich plasma and autologous fat have recently gained increasing attention because of beneficial pain-reducing effects in arthritis and the associated regenerative potential. However, the extent of clinical evidence in this area and how well autologous substances work in terms of pain reduction and improvements in hand function remain unclear. METHODS A systematic review and meta-analysis were conducted to evaluate the current evidence and to provide more insight into pain reduction and improvement in hand function after infiltration of autologous substances. The authors identified 11 clinical trials, of which we included eight in the meta-analysis. RESULTS Autologous substances achieved a good and long-lasting pain reduction, which may also be accompanied by corresponding improvement in hand function. Autologous substances appear to be more effective than corticoid infiltrations. The infiltration of autologous fat seems to be particularly promising in more advanced stages of carpometacarpal arthritis of the thumb. Our meta-analysis showed a mean pain reduction of 2.4 to 3 in visual analogue scale score and a reduction of 18 to 19 points in the Disabilities of the Arm, Shoulder, and Hand questionnaire after infiltration with autologous substances. CONCLUSION Both platelet-rich plasma and autologous fat infiltration offer an efficient and long-lasting, minimally invasive therapy option in the treatment of carpometacarpal arthritis of the thumb.
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Affiliation(s)
- Raimund Winter
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Sophie K Hasiba-Pappas
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Alexandru-Cristian Tuca
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Robert Zrim
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Sebastian Nischwitz
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Daniel Popp
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - David Benjamin Lumenta
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
- Research Unit for Digital Surgery, Medical University of Graz
| | - Werner Girsch
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Lars-P Kamolz
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
- COREMED, the Cooperative Centre for Regenerative Medicine, Joanneum Research GmbH
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Holzbauer M, Schmidt M, Mihalic JA, Duscher D, Froschauer SM. Liparthroplasty for Thumb Carpometacarpal Joint Osteoarthritis: A Case Series with Median 5 Years of Follow-Up. J Clin Med 2022; 11:6411. [PMID: 36362639 PMCID: PMC9656523 DOI: 10.3390/jcm11216411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 02/29/2024] Open
Abstract
Liparthroplasty has recently been discussed as a promising bridging therapy after failed conservative treatment options to postpone arthroplasty surgery of the thumb carpometacarpal joint as long as possible. The current study investigates the sustainability of this method in seven stage II and twenty-four stage III osteoarthritis patients (twenty-seven female and four male cases). Data were evaluated preinterventionally, six months postinterventionally, and two years postinterventionally, as well as a final follow-up assessment after median 5.1 years. We found a significant reduction of all postinterventional disabilities of the arm, shoulder, and hand (dash) scores and pain levels compared to the ones prior to liparthroplasty. Moreover, we even detected a reduction in both parameters within the postinterventional course, so that the DASH scores of our final investigation were significantly lower than the values after six months. Furthermore, 12 of our 31 cases demanded a surgical conversion due to recurrence of symptoms. A binary regression analysis found smokers to have 11 times higher odds for therapy failure, leading to surgical conversion. Seventeen out of nineteen patients in our final assessment stated that they were pleased with liparthroplasty. Due to favorable mid-term outcomes of 61% of the 31 initially treated patients, we recommend liparthroplasty as a reliable bridging therapy for preserving joint integrity as long as possible, especially in non-smoking patients.
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Affiliation(s)
- Matthias Holzbauer
- Department for Orthopedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria
| | - Manfred Schmidt
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria
| | - Julian Alexander Mihalic
- Department for Orthopedics and Traumatology, Med Campus III, Kepler University Hospital, Krankenhausstrasse 9, 4020 Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria
| | - Dominik Duscher
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076 Tuebingen, Germany
| | - Stefan Mathias Froschauer
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria
- Diakonissen Clinic Linz, Weißenwolffstrasse 15, 4020 Linz, Austria
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Karagergou E, Ligomenou T, Chalidis B, Kitridis D, Papadopoulou S, Givissis P. Evaluation of Adipose Cell-Based Therapies for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis. Biomolecules 2022; 12:biom12030473. [PMID: 35327665 PMCID: PMC8946069 DOI: 10.3390/biom12030473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Adipose tissue and its regenerative products which are isolated with enzymatic or mechanical processing of the harvested fat have been studied in a wide range of degenerative diseases, including osteoarthritis of the knee and hip. Intra-articular injection of these products can provide symptomatic relief of pain and postpone surgery. However, their use in the treatment of thumb carpometacarpal joint (CMCJ) osteoarthritis is limited and just a few studies have been published on that topic. For this reason, a review of the literature was performed by a thorough search of eight terms using the Pubmed database. In total, seven human studies met the selection criteria, including case-control studies, case-series and one case report. In all studies, intra-articular injection of autologous fat in osteoarthritic thumb CMCJ provided reduction in pain and improvement in hand function. Grip and pinch strength showed variable results, from no change to significant improvement. Fat-processing techniques were based on centrifugation and mechanical homogenization but biological characterization of the injected cells was not performed in any study. Although the results are encouraging, a uniformly standardized method of fat processing and the conduction of randomized controlled trials in the future could better evaluate the effectiveness of this procedure for thumb CMCJ osteoarthritis.
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Affiliation(s)
- Eleni Karagergou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
- Correspondence: ; Tel.: +30-69-7238-6716
| | - Theodora Ligomenou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
| | - Byron Chalidis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
| | - Sophia Papadopoulou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
| | - Panagiotis Givissis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
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[Minimally invasive procedures in the early stages of trapeziometacarpal joint osteoarthritis : Denervation, arthroscopy and autologous fat transplantation]. DER ORTHOPADE 2022; 51:13-22. [PMID: 35015097 DOI: 10.1007/s00132-021-04198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Resection arthroplasty of the trapezium with or without tendon interposition is the standard procedure in the treatment of advanced, symptomatic thumb carpometacarpal joint osteoarthritis. Treatment recommendation in the early stages without visible or minimal radiographic changes is often difficult, especially when conservative treatment methods have already been exhausted. In these cases, there is the possibility of the minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation. OBJECTIVES Which minimally invasive procedures are available for the treatment of thumb carpometacarpal joint osteoarthritis and how is their value to be assessed? METHODS The minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation for the treatment of thumb carpometacarpal joint osteoarthritis are described and current results from the literature are discussed. RESULTS Good results have been reported with all three procedures. However, the reports are almost exclusively based on retrospective studies with small numbers of patients, which lack control groups, so the results cannot be regarded as definitive. CONCLUSIONS Denervation, arthroscopic procedures and autologous fat transplantation appear to be suitable methods in the early stages of thumb carpometacarpal joint osteoarthritis. Further studies, especially comparative randomised trials that report medium and long-term results, would allow further assessment of these methods.
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