‘Thumbs Up‘: Surgical Management and Outcome of Primary Osteoarthritis at the Base of the Thumb

Abstract

‘One does never operate on a bone you can swallow’, said Sir John Charnley (1911–1982) a pioneer in orthopaedic surgery. For many years this was probably the best thing to do, because surgical treatment of wrist and hand problems was not yet common knowledge. Nowadays, due to research and innovation, surgery on small bones can be the right treatment in wrist and hand problems. Hand osteoarthritis (OA) is one of the most common OA phenotypes, after knee OA and hip OA. OA at the base of the thumb is, after distal interphalangeal joint OA, the most common affected joint in the hand and can cause severe pain, weakness and deformity, which can result in significant disabilities. It typically affects postmenopausal women in their fifth to sixth decade of life. Dahaghin et al. showed in a population-based cohort (n = 3906; 54.8% female) aged 55 and older that the prevalence of radiographic OA of the first carpometacarpal (CMC) joint and scaphotrapezial (ST) joint is rather high (35.8%). Furthermore, they confirmed a modest association between hand pain and radiographic OA, the strongest relationship being with the first CMC and ST joint compared to the other joints in the hand (OR; 1.9, CI 1.5–2.4). Hand disability, however, showed a rather weak association with radiographic OA, of which the first CMC and ST joint were not statistical significant (OR; 1.3 CI 1.0–1.9)