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Fat Transplantation in CMC I Arthritis - Operative Technique and Preliminary Results
Riccardo E. Giunta, MD, PhD; Elisabeth Haas, MD, PhD; Elias Volkmer, MD, PhD
Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie, Klinikum der Ludwigs-Maximilians Universität München, München, Germany

Objective: Many treatment options of CMC I arthritis include a partial or total resection of the trapezium and thus alter the anatomy of the hand. Despite the sustained success of the final restoration to less invasive treatment options are view. Fat tissue containing adipose tissue derived stem cells (ADSC) have already been reported a regenerative effect in other areas of the body. Therefore, it was our objective to evaluate the outcome of autologous fat injection into the carpometacarpal joint to achieve symptom relief and a postponement of definitive surgical solution.

Materials and Methods: In a pilot study, 10 patients, both men and women treated. Inclusion criteria were age over 18 years, symptomatic CMC I arthritis with a VAS of at least 40mm / 100mm. Liposuction of the abdominal fat was performed under local anesthesia. There were injected between 1 and 2.5ml of fat obtained under fluoroscopy in the carpometacarpal joint. There was an immobilization of the joint for 10 days in a splint. Follow-up studies included radiographs, grip strength and pinch grip measurements, ROM, Michigan Hand Questionnaire and Quick Dash and were carried out after 1,2,6 weeks and 3,6 and 12 months.

Results: There were no relevant side effects in our study. Patients reported an increase in the pain during the first 2 weeks after operation. After 2 weeks postop we have seen a consistent reduction of pain, both at rest and during exercise. In rest nearly a pain relief was achieved. Both the increase in grip strength and the strength of the pinch grip, as well as a reduction of the DASH and MHQ could be achieved postoperatively.

Summary: Our preliminary results suggest that autologous fat injection is a promising new treatment option in the arthritic changes in the CMC I joint. This new method is safe, few side effects and can be performed under local anesthesia. Although the instability of advanced rhizarthrosis can not be treated with this alternative, the definitive operation, be pushed in terms of a resection arthroplasty at least for months or years, the evaluation of the medium- and long-term outcomes is necessary to make a statement about the sustainability of this method can make. However, it remains unclear whether "cushioning" and scaring of the joint or the regenerative potential of included ADSC is responsible for the clinical effect.

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