Published online Aug 18, 2019. doi: 10.5312/wjo.v10.i8.304
Peer-review started: February 15, 2019
First decision: June 12, 2019
Revised: June 24, 2019
Accepted: July 8, 2019
Article in press: July 8, 2019
Published online: August 18, 2019
Basal joint arthritis is a common disease which is especially present in post-menopausal women. A variety of procedures have been described once conservative treatment has failed. The purpose of our study is to present a novel surgical technique based on a clinical case with three-year follow-up which is highly effective, even after failure of previous procedures.
We present a case of a 39 year-old-woman who suffered from recurring, persistent, sharp left thumb pain for several years. After two operative procedures, she presented again with intolerable, sharp pain over the trapeziometacarpal joint, and wished to proceed with a pain relieving procedure or arthroplasty. Intraoperatively, the articular surfaces appeared well, without any bare areas of bone or eburnation, resulting in the decision to perform a “subtraction hemiarthroplasty”. A shortening osteotomy of the os trapezium was performed by removing a slice of 8-9 mm bone, without damaging the joint cartilages. The osteotomy was stabilized using two screws, the ligament and capsular tissue was suture imbricated, and a cut down on the translation and a dorsal radial ligament reconstruction were performed. Three years after the final procedure, a long-term follow-up demonstrates excellent results, pain free with full range-of-motion.
Subtraction hemiarthroplasty with ligament tightening imbrication and reconstruction of the radial ligament led to excellent results in motion and pain.
Core tip: Even after failure of two index procedures, the subtraction hemiarthroplasty technique with ligament tightening imbrication and reconstruction of the radial ligament can lead to excellent results in both motion and pain. This can be a good alternative to a more aggressive treatment approach, such as arthroplasty, arthrodesis, or hemitrapeziectormy, and should be considered in select patients.