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Selective Denervation with Autologous Fat Transplantation for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis
Charles Nolte, BS
1, Evan J. Haas, BS
1, Ross Moseley, BS
1, Anna D. Lee, MD
1,2, Carson Keeter, MS
1, Louis W. Catalano, MD
3, Mark A. Greyson, MD
3; Matthew Belton, MD
4(1)University of Colorado School of Medicine, Aurora, CO, (2)New York University, New York, NY, (3)University of Colorado Anschutz Medical Campus, Aurora, CO, (4)University of Colorado, Aurora, CO
Introduction:Thumb carpometacarpal (CMC) osteoarthritis is a common source of chronic hand pain and disability. Traditional surgical treatments-such as trapeziectomy or implant arthroplasty-are effective but involve significant anatomical disruption and recovery. Recently, two joint-preserving techniques-selective CMC denervation and autologous fat transplantation (AFT)-have independently emerged as promising alternatives. Denervation reduces nociceptive input by disrupting articular nerve supply, while AFT may support joint preservation through mechanical cushioning and inflammation modulation. Although each technique has been used independently, their combined application has not been previously studied. This case series presents the first clinical outcomes evaluating the safety and short-term efficacy of selective denervation with AFT.
Materials & Methods:This was a prospective case series of adults with Eaton-Littler Stage I-IV thumb CMC osteoarthritis treated with combined selective denervation and AFT. Demographic data, comorbidities, surgical characteristics, adverse events, and follow-up outcomes were collected. Objective outcomes included grip strength, 3-point pinch, key pinch, and Kapandji opposition scores. Patient-reported outcomes included PROMIS Upper Extremity (PROMIS-UE), PROMIS Pain Interference (PROMIS-PI), QuickDASH, and visual analog scale (VAS) pain scores. Patients were evaluated at 2-weeks, 6-weeks, and 3-months postoperatively.
Results:
Thirteen patients (mean age 57.9 ± 13.0 years; 77% female; mean BMI 29.1 ± 4.3) underwent surgery. No intraoperative complications occurred. Two patients (15%) experienced minor adverse events-one superficial infection and one instance of persistent pain requiring corticosteroid injection. No revisions were performed [See Table 1].
Grip strength returned to baseline by 6-weeks, while 3-point and key pinch strength improved by 32% and 43%, respectively, at 3-months. Kapandji scores increased from 8.1 to 10.0, indicating restored thumb opposition. PROMIS-UE and QuickDASH scores showed functional improvement beginning at 6-weeks. VAS pain scores improved by 26%, 30%, and 53% at 2-weeks, 6-weeks, and 6-months, respectively [See Table 2].
Conclusions:
This is the first clinical study to evaluate combined selective CMC denervation with AFT for thumb CMC osteoarthritis. The novel surgical technique was safe, well tolerated, and associated with early improvements in both objective and patient-reported outcomes. While limited by small sample size and short-term follow-up, these early findings highlight the potential of this novel, joint-preserving technique and support further prospective investigation.
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