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Outcomes of Stage III Thumb Carpometacarpal Joint Osteoarthritis Treated With Arthroscopic Fusion
Esther Chow, MD
United Christian Hospital, Hong Kong, Hong Kong

Introduction
The thumb carpometacarpal joint (CMCJ) is one of the most common site of pathology in the hand. When conservative treatment fails, surgical treatment is recommended. However, there are variety of surgical options including ligament reconstruction tendon interposition, osteotomy, fusion and arthroplasty. With the advancement in hand arthroscopy, the use of arthroscopic assisted treatment has become more popular. However, no previous studies had reported on the results of arthroscopic fusion for Eaton III Thumb CMCJ Osteoarthritis. This study prospectively evaluate the subjective and objective results of Eaton stage III thumb CMCJ osteoarthritis treated with arthroscopic fusion.

Materials and Methods
From March 2013 to March 2016, Nine patients with Eaton Stage III thumb CMCJ osteoarthritis were treated with arthroscopic fusion. They were evaluated objectively with grip strength, pinch strength, range of motion and Kapandji score. They were also evaluated subjectively with Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the visual analog scores (VAS) for pain. These were assessed before surgery, 3 months after surgery and 6 months after surgery. The radiographs were assessed at the latest follow-up.

Results
The average age was 64.3 years old. All nine patients were female. The pre-treatment VAS was average 5.8; the pre-treatment average DASH was 44.8. The average change in VAS and DASH was -3.8 and -4.27 at 3 months; -4.8 and -14.8 at 6 months. The change in Grip and pinch strength was +0.45kg, -0.15kg at 3 months; +4.0kg and +0.45kg at 6 months. There was one case of pseudoarthrosis. There were no wound complications and no implant related complications.

Conclusion
Arthroscopic fusion is a feasible treatment option for Stage III thumb CMCJ osteoarthritis. It provides excellent pain relief and improves hand function as early as 12 weeks after the surgery. This treatment also proved to have improved the grip strength and pinch strength at 6 months after the surgery.


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