Osteoarthritis

Epidemiology

 

Male & Females > 60 years

- X-ray evidence of OA

 

Symptomatic 

- 25% females

- 15% males

 

Affected joints

 

Base thumb

PIPJ / Bouchard's nodes

DIPJ / Heberden's nodes

 

 

3 Groups

 

1.  Heberden's nodes

2.  Basilar thumb & Heberden's 

3.  Heberden's and Bouchard's

 

Xray

 

Joint space narrowing

Subchondral sclerosis

Osteophyte formation

 

 

Management

 

Options

 

Arthrodesis

Arthroplasty

 

DIPJ Arthrodesis

 

 

Position

- 15 - 20^o flexion

 

Incision

- transverse incision over DIPJ / H

- split / divide extensor tendon

- resect with small bone cutters and nibbles

 

Options

 

A.  Headless compression screw

 

 

B.  K wire and TBW

- single intra-axial K wire

- pass retrograde first, reduce, anterograde

- Circular wire

- small drill holes and pass 25 or 26 gauge wire

- tension

 

 

PIPJ Arthrodesis

 

Best in RF / LF

 

Position

 

IF / MF

- 25 - 35^o

 

RF / LF

- 45 - 50^o

 

Technique

 

Longitudinal incision

 

Options

 

A.  Reflect central slip

- leave attached distally

- lateral bands remain 

- suture repair at end

 

B.  Interval between central slip and lateral band

- reflect central slip laterally

 

Release collateral ligaments

- leave volar plate intact

- create two opposable surfaces

- saw or bone nibbler

 

Fixation

 

A.  Headless compression screw

 

B.  Crossed K wires

 

C.  Longitudinal K wire and TBW figure 8

- pass wire retrograde 

- reduce, pass distally into P2

 

 

Results

 

Fusion rates about 90%

 

Arthroplasty

 

See rheumatoid hand discussion