Thumb Carpometacarpal Arthroplasty for Advanced Osteoarthritis

Introduction to Surgical Intervention

Surgery, including interposition arthroplasty, osteotomy, or arthrodesis, is an effective treatment for severe thumb base osteoarthritis and should be considered in patients with marked pain and/or disability when conservative treatments have failed, as recommended by the European League Against Rheumatism (EULAR) 1, 2, 3, 4

The EULAR guidelines provide Level III evidence with a strength of recommendation of 68 (95% CI: 56-79), indicating moderate support for surgical intervention, according to the EULAR guidelines 2, 4
Numerous observational studies support surgery as clinically effective for severe thumb base OA refractory to conventional treatments, with the EULAR guidelines acknowledging the need for further research 2, 4

Failure of conservative management, including activity modification, splinting, topical NSAIDs, oral analgesics, and exercise regimens, is an indication for surgical intervention, as suggested by the EULAR guidelines 1, 3
Failure of intra-articular corticosteroid injections for painful flares is also an indication for surgery, according to the EULAR guidelines 2, 4
Marked pain and/or disability that limits activities of daily living is a key consideration for surgical intervention, as recommended by the EULAR guidelines 2, 4

The EULAR guidelines recommend not operating without exhausting conservative measures first, as the treatment algorithm requires stepwise progression through non-pharmacological, pharmacological, and invasive non-surgical options 1, 3

Surgery, including the BioPro thumb carpometacarpal hemiarthroplasty, is a viable option for severe thumb base osteoarthritis, but should only be considered when conservative treatments have failed and the patient has marked pain and/or disability, as recommended by the Annals of the Rheumatic Diseases 5, 6, 7
The American College of Rheumatology suggests that surgery is clinically effective for severe thumb base OA refractory to conservative treatments, with multiple surgical techniques available including arthrodesis, trapeziectomy, and various joint replacement options 6, 7

The European League Against Rheumatism (EULAR) guidelines recommend first-line conservative management, including activity modification, education, heat application, topical NSAIDs, oral analgesics, and exercise regimens for range of motion and strengthening, as outlined in Praxis Medical Insights 8
Second-line invasive non-surgical options include corticosteroid injections for painful flares, as recommended by Praxis Medical Insights 8
Third-line surgical options, including the BioPro thumb insert, should be considered when patient has marked pain and/or disability and conservative treatments have failed, as suggested by the Annals of the Rheumatic Diseases 5, 6, 7

The EULAR guidelines note that the potential benefits of surgery compared with conservative management, and the most appropriate surgical procedure for thumb base OA, remain to be determined, highlighting the need for further research 9