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Treatment for CMC arthritis using a novel, trapezium sparing Pyrocarbon spacer
Henry Leis, MD
1, Garry Pollock, MD
2; Michael Jones, MD
3(1)Bienville Orthopedic Specialists, Gulfport, MS, (2)The Hand Center, Lubbock, TX, (3)Center for Orthopedic Surgery and Sports Medicine, San Antonio, TX
Introduction:The Ensemble CMC is an interpositional pyrocarbon spacer that is used to treat early to moderate basal thumb arthritis (Figure 1). The device profile allows for separation of the damaged articular surfaces of the trapezium and metacarpal without extensive bone resection or disruption of the surrounding tissue. This retrospective review describes the Ensemble CMC surgical technique and reports the initial clinical experience of three surgeons.
Materials and Methods:The CMC joint was prepared using one of two techniques: 1) an open Wagner approach to access the joint, remove osteophytes, and shape the bone, and 2) arthroscopic osteophyte removal followed by the enlarging of the R1 port to allow further shaping of the bone. The implant size was then selected using trials which were inserted to confirm optimal size, appropriate ligamentous tensioning, and normal range of motion of the joint, specifically opposition, before the final pyrocarbon implant was inserted. The capsule was repaired and the skin was closed. Motion at the thumb joint was limited for the first 2-3 weeks to promote capsular healing. A retrospective protocol, approved by the WCG IRB, was followed to collect clinical and radiographic outcome data at each of the three sites.
Results:Ninety-one Ensemble CMC cases were performed on 83 patients between March 2021 and December 2022. The average age of patients was 63.1 years (range 39-82), 76% were female, and 52% received the implant in the right thumb. Two surgeons prepared the joint using the open Wagner approach (66% cases) and one used the arthroscopic technique. Five patients (5.5%) required revision surgery due to pain, four of which occurred within the first year following surgery. There was no difference in the reoperation rate between the two techniques. Four patients were revised to the LRTI and one patient was revised back to the Ensemble CMC implant following a traumatic fall. Notably, four of the five revisions were among the surgeon's first or second cases, indicating a potential learning curve. There were no dislocations or device failures reported.
Conclusion:The Ensemble CMC was shown to provide a viable surgical option for the treatment of early to moderate stage basal thumb arthritis at each of the three sites. Short-term outcomes demonstrate high implant survival and clinical usefulness.
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