Gold Coast Orthopaedic Hand Surgeon Dr Michael Maguire initially offers non-operative treatment for base of thumb arthritis. If conservative treatment is unsuccessful, Pyrocarbon Joint Replacement Surgery offers a good solution.
Dr Maguire uses the Tornier Pyrocardan prosthesis for isolated CMC Joint arthritis and sometimes for combined CMC and STT Joint Arthritis of the thumb.
The specific design of the Pyrocardan (2 cylindrical concavities -
orthogonales) reproduces the complex movements of the TMC articulation
while ensuring its stability.
The surgical technique is as follows.
Incision over base of thumb.
Capsule flap rasied based on trapezium.
Metacarpal base cut with saw.
Trapezium cut with saw.
Metacarpal base rounded to a spherical shape and trapezium smoothed to a cylindrical shape with a burr.
Trapezium shaped to cylinder with burr.
Different sized "trial" implants used to select best fit.
The Pyrocardan can be implanted using a minimally invasive approach.
Final implant inserted.
Strong closure allows early movement after two weeks.
Subcuticular closure provides cosmetic wound healing.
Excellent range of motion results.
(Photos courtesy of Dr Phillipe Bellemere, Nantes, France)
Dr Maguire uses the Tornier PI2 prosthesis for more severe base of thumb arthritis when the Scapho-trapezial and trapezial metacarpal joints are both involved.
In this situation the entire trapezium is removed and the trapzeium is replaced with the pyrocarbon PI2 prosthesis and a ligament reconstruction performed.
