Rhizarthrosis


Introduction

Rhizarthrosis, o arthrosis at the base of the thumb, or trapeziometacarpal arthrosis is a common pathology that affects 20% of population over 50 years old, most women.

This arthrosis at the base of the thumb is found at the level of two bones: trapeze and first metacarpal, causing in the joint, a chronic and progressive wear away of the cartilage that covers this trapeze and first metacarpal (trapeziometacarpal arthrosis).



Rhizarthrosis occurs mostly in women between 50 and 60 years old, and in most of the cases, in both hands.

Cartilage wear and tear presents all the typical symptoms of arthrosis, so patients affected by this disease have a localized pain at the base of the thumb.

It is common that patients suffer from episodes of severe pain located at the root of the thumb (close to the wrist), which increase with movement and the hand strenght.

The thumb movements decrease over time and cause a progressive stiffness of the finger, especially when you open the hand.

Patients show a lack of strenght in the index and thumb fingers; and in the most developed cases there is a deformation of the thumb due to bone spurs (osteophytes) in the affected joint.

For these patients, opening a bottle is not an easy challenge to achieve.

A complete medical history and an x-ray with Kapandji projection allow an accurate diagnosis and to choose the best treatment.

When the conservative medical treatment has been carried out for at least 6 months and it is ineffective, the only solution is surgery. The type of surgery will depend on the level of arthrosis and the kind of manual activity.


Treatments

Trapeziometacarpal arthrodesis:

This is the most radical solution to the problem. It consists in fixing the thumb in a way that it cannot move any more. At Clínica Planas it is used only for certain special cases, such as patients that have undergone surgery many times with the same problem, so the joint cannot be preserved any longer.

Trapeziectomy with tendon repair:

It involves the ablation (removal) of the trapezium taht will be replaced by a tendon from the forearm (tenoplasty) to avoid the shortening of the finger.
Although this kind of surgery relieves pain, it affects the tendon of the wrist since it will be used to fill the empty space left by the trapezium removal.



                                               

As this surgery does not reconstruct the joint affected by arthrosis, the patients show a reduction of the strenght of their thumb and wrist. This kind of surgery is carried out at Clinica Planas only for those older patients with a few functional needs.

Pyrocarbon prosthesis

More than prosthesis, they are pyrocarbon spacers.
This material is obtained by a combustion process of an isotope of carbon, and the products manufactured with this material have a good resistance, low wear coefficient and elasticity.

As this surgery does not reconstruct the joint affected by arthrosis, the patients show a reduction of the strenght of their thumb and wrist. This kind of surgery is carried out at Clinica Planas only for those older patients with a few functional needs.

Pyrocarbon prosthesis

More than prosthesis, they are pyrocarbon spacers.


This material is obtained by a combustion process of an isotope of carbon, and the products manufactured with this material have a good resistance, low wear coefficient and elasticity.

There are spacers with different shapes, but all of them have the same function of filling the empty space after the trapezium removal.

                                  

In fact, this type of surgery is the same as the trapeziectomy with tendon repair, but instead of the tendon, the spacer is used as a filling material, preserving then, an important tendon of the wrist. At Clinica Planas we use this technique only for those patients with a few functional needs of the hand, as well as in the trapeziectomy with tendon repair.

Trapezial-metacarpal prosthesis

The purpose of the trapezial-metacarpal prosthesis is to eliminate the pain and restore the length of the thumb; and therefore, its strenght and movement.

The surgical procedure is usually carried out under local-regional anesthesia (only the arm is numbed) on an outpatient basis.

This surgery consists of implanting a similar prosthesis to the hip one, which consists of a stem, a head and a cup. The only difference is that it will not have to bear the body weight.



The procedure consists of removing the part of the worn bone and replaces it with the prosthesis, which will work as a normal joint.

       

There are different formats of prostheses (retentive, double mobility, cemented, press-fit). The specialist will assess the most suitable for each patient needs.

This surgery is the most recommended and used at Clinica Planas for the advanced rhizarthrosis.


Post-Treatment


Recovery is quick, and rehabilitation starts 2-3 weeks after surgery with the first movements of the thumb.

You will be able to increase the strenght of the hand 3 months after surgery.



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