Our Summary

The research paper explores a surgical procedure for those with certain conditions that affect the thumb, such as osteoarthritis, thumb instability due to malformations, ligament looseness, and joint hypermobility. The procedure, bony fusion of the trapeziometacarpal joint, involves removing the joint surfaces, temporarily installing a K-wire, and applying a T-shaped plate. After surgery, the patient’s arm and thumb are immobilized for eight weeks and undergo standard radiographs. Once the bone heals, guided exercises are prescribed to increase strength and mobility, with full loading for manual tasks possible after three months.

The procedure has generally good results in terms of strength, stability, and pain reduction, with a high satisfaction rate among patients. However, some complications related to the implant, and non-healing of the fusion happens in about 13% of patients. Despite this, the procedure is still recommended for young manual workers who can tolerate some mobility limitations. It is not recommended for those with osteoarthritis or stiffness of nearby joints, those who require maximum thumb mobility, or those with insufficient bone stock.

FAQs

  1. What conditions can the bony fusion of the trapeziometacarpal joint procedure treat?
  2. What is the recovery process like after undergoing a bony fusion of the trapeziometacarpal joint procedure?
  3. Who is the bony fusion of the trapeziometacarpal joint procedure recommended for and not recommended for?

Doctor’s Tip

A helpful tip a doctor might tell a patient about joint fusion is to follow post-operative instructions carefully, including immobilization and rehabilitation exercises, to ensure successful healing and recovery. It is important to communicate any concerns or complications to your healthcare provider promptly to address them effectively. Additionally, maintaining a healthy lifestyle, including proper nutrition and regular exercise, can support the healing process and overall joint health.

Suitable For

Typically, patients who are recommended joint fusion are those with conditions such as osteoarthritis, thumb instability due to malformations, ligament looseness, and joint hypermobility. These patients may experience pain, instability, and limited function in their thumb joint, which can be improved through joint fusion surgery. It is important for patients to have good bone stock and be able to tolerate some mobility limitations in order to benefit from this procedure. Patients who are not recommended for joint fusion include those with osteoarthritis or stiffness of nearby joints, those who require maximum thumb mobility, and those with insufficient bone stock.

Timeline

Before joint fusion:

  1. Patient experiences symptoms such as pain, instability, and limited mobility in the thumb.
  2. Patient undergoes consultations and diagnostic tests to determine the need for joint fusion surgery.
  3. Surgical procedure, bony fusion of the trapeziometacarpal joint, is recommended and scheduled.

After joint fusion:

  1. Surgery is performed, involving removal of joint surfaces, installation of K-wire, and application of a T-shaped plate.
  2. Patient’s arm and thumb are immobilized for eight weeks post-surgery.
  3. Standard radiographs are taken to monitor bone healing.
  4. Guided exercises are prescribed to increase strength and mobility.
  5. Full loading for manual tasks becomes possible after three months.
  6. Patient experiences improvements in strength, stability, and pain reduction.
  7. Complications related to the implant and non-healing of the fusion may occur in some cases.
  8. Procedure is recommended for certain patient populations but not for others based on specific criteria.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with joint fusion surgery?
  2. How long is the recovery process after joint fusion surgery?
  3. What type of rehabilitation or physical therapy will be needed after the surgery?
  4. How soon after surgery can I expect to regain full use of my thumb?
  5. Are there any long-term effects or limitations that I should be aware of after undergoing joint fusion surgery?
  6. Are there any alternative treatments or procedures that I should consider before deciding on joint fusion surgery?
  7. How successful is joint fusion surgery in relieving pain and improving function in patients with my specific condition?
  8. Will I need to have the hardware (such as plates or screws) removed after the fusion has healed?
  9. What type of follow-up care will be necessary after the surgery?
  10. Are there any specific lifestyle changes or precautions I should take after joint fusion surgery to ensure the best outcome?

Reference

Authors: Pillukat T, Mühldorfer-Fodor M, Fuhrmann R, Windolf J, van Schoonhoven J. Journal: Oper Orthop Traumatol. 2017 Oct;29(5):395-408. doi: 10.1007/s00064-017-0515-7. Epub 2017 Aug 9. PMID: 28795210