Osteoarthritis (OA) of the 1st carpometacarpal joint (CMCJ) is a debilitating condition as the thumb comprises up to 50% of hand function, limiting work and recreational activities. Surgical management of Eaton-Littler stage II-III 1st CMCJ OA is variable and include trapeziectomy with or without tendon interposition or tightrope suspension, implant arthroplasty or arthrodesis depending on patient needs. We wish to share our local experience over a 10-year period of using the Pyrocardan implant in comparison to trapeziectomies looking at patient reported and functional outcomes.
Method: Retrospective review of all 1st CMCJ arthroplasties performed by single senior surgeon (BN) from January 2013 to December 2023. Looking at perioperative outcomes, revision rates, functional outcomes by hand therapy and patient reported outcomes.
Outcomes: 39 patients with 40 primary arthroplasties and 4 revision arthroplasties identified with mean follow up of 13 months. Revision rates for primary arthroplasty is 15% (6 of 40) and were for persisting pain beyond 6months, OA progression, and implant displacement. QDASH scores showed reduction of 28 points by 6 weeks, and 43 points by 6 months amongst responders. Median Kapandji score at last follow up was 9. By 3 months grip strength and pinch were 66% and 56% of contralateral side and at 6months were 70% and 79% respectively.
Conclusion: Pyrocardan interposition arthroplasties are a good option for 1st CMCJ OA with immediate improvements in QDASH scores within 6 weeks post op. Potential for revision, especially during the initial learning curve, must be noted and usually occurs within the first 6 months.