Open surgery VS endoscopic procedure:
Traditional Open surgery:
Most variants usually involve:
- Two or sometimes three different open incisions
- Complete removal of the arthritic bone (Trapezium)
- Tendon removal from forearm used for thumb stabilization (ligament reconstruction)
- Associated with different degrees of thumb shortening and weaker pinch strength.
- Excellent pain relief
Arthroscopic procedure at EHI:
- Done through two 2 mm incisions made along the thumb base joint line, a 1.9 mm scope allows magnified view of joint surface and surrounding ligaments. This view and additional live x-ray technology allow complete joint assessment and guidance for a targeted treatment.
- Bone spurs and arthritic joint surface are debrided using a special small burr, increasing joint space and contouring a smooth joint surface.
- Then, a special “collagen” Allograft patch is placed and used as joint interposition and resurfacing material to act as cushion between the bones.
- Preserving the Trapezium bone (removed in traditional open surgery), helps maintain support to the thumb. This results in no thumb shortening and is usually associated with improved pinch strength.
Outcomes: Open Vs Endoscopic Surgery
Many research studies evaluating clinical outcomes have compared different surgical treatments for this condition to traditional open surgery. The specific benefits of arthroscopic procedure include:
- faster recovery, less pain
- less scar tissue formation
- less stiffness, no need for tendon graft harvest
- less thumb shortening, better pinch strength
- greater patient satisfaction
Menon introduced the first thumb arthroscopic procedure in 1996
“Results revealed no loss in range of motion, an average increase in pinch strength in 20 of 31 patients, “no loss of preoperative range of motion, and subjective reports of no pain, or pain with exertional activities in 88% of patients” (quote) Menon J. Arthroscopic management of trapeziometacarpal joint arthritis of the thumb. Arthroscopy. 1996; 12(5):581–587. doi:10.1016/S0749-8063(96)90198-X [CrossRef]
“Within the past 2 decades, the arthroscopic treatment of carpometacarpal arthritis
has yielded satisfactory results, particularly with respect to pain relief”
Min Jung Park, MD, MMSc; Arthur T. Lee, MD; Jeffrey Yao, MD
December 2012 – Volume 35 • Issue 12: e1759-e1764