BAPRAS Winter Meeting 2019

Over the last 10 years my preference for the surgical treatment of early (stage II) thumb basal joint arthritis has been interposition arthroplasty with Pyrocarbon Disc. This operation fits a selected group of patients who have become resistant to conservative measures, especially splints and steroid injections, but who are symptomatic enough to request surgery. Treatment with this particular prosthesis is less invasive then other procedures, yet it allows a successful conversion to conversional trapeziectomy in case of problems. Outcomes from over 30 patients I have operated so far, start to emerge as reliable and conclusive at average follow up of 4 years. Assessment of all prosthesis based operations requires patience so monitoring of my cohort of patients continues. Abstract with more details is available below.

Pyrocarbon Interposition Arthroplasty for The First Carpo-Metacarpal Joint Osteoarthritis –
mid to long term outcome analysis (Abstract of presentation delivered in Monaco)

Talk presents a mid to long-term result and operative technique on use of a pyrocarbon, non-
anatomical implant for arthrosis of the first carpo-metacarpal joint (CMCJ) arthritis.
Materials and Methods:
Data was collected prospectively for 28 patients (average age 56) with radiological stage I – III
arthroses who failed conservative management and underwent interposition arthroplasty over
the last 9 years.
Key Results:
Patient satisfaction remains high: 89% of patients would undergo operation again. Both pain
and DASH score improvement was significant (p< 0.01 for both) at mean 48 months of follow
up. Pinch and grip strength have also improved but less dramatically (p> 0.05). Thumb mobility
was restored to that of the contralateral thumb at average 7 months post surgery in 75% and at
1 year in 89% of cases. Two patients suffered implant subluxation, both due to FCR sling failure.
One underwent subsequent trapeziectomy and another, a revision surgery with larger
prosthesis. Mild, but asymptomatic periprosthetic lucency has been detected in 15% of cases at
3 years.
During the presentation a short video will demonstrate actual surgical technique which includes
minimal osteotomies of the trapezium and thumb metacarpal base via volar approach and
stabilization of the implant and the joint with the sling of the flexor carpi radialis tendon.
Conclusions:
Mid-long term results of pyrocarbon interposition arthroplasty in treatment of early CMCJ
arthrosis appear encouraging and appreciated by vast majority of patients in this cohort. Critical
analysis of cost effectiveness and long term results against alternative surgical options is now
due.