France — Considered to be the result of an injury or simply an aspect of aging, rhizarthrosis, or thumb osteoarthritis, is often viewed as an inevitability of life. Yet many people are unaware that there are effective and long-lasting treatments that can help. This is why an informational website was launched (see box at the end of this article). Here, physicians and surgeons who specialize in hand surgery, as well as manufacturers who make products for this field, can keep up on the available treatment options — particularly surgical treatment.
Patients Predominantly Women
Of the 10 million people in France who have osteoarthritis, 1.8 million have thumb osteoarthritis. This progressive disease can result in complete loss of mobility in the hand, making it painful, if not impossible, to carry out essential everyday activities, such as taking the cap off a bottle, opening a package, cooking, typing on a keyboard, and performing manual tasks.
The condition is caused by the breakdown of cartilage, which can occur rapidly or over the course of several years. The joint between the trapezium (a carpal bone found at the base of the thumb) and the first metacarpal bone gets worn down, preventing the thumb from functioning normally (gripping or pinching). Often occurring bilaterally, rhizarthrosis has many causes, including anatomic predispositions, heredity, aftereffects of injuries, and repetitive manual labor.
“In most cases, rhizarthrosis is characterized by pain, decreased grip or pinch strength, stiffness of the thumb column (bringing about mobility problems), and joint deformities, including what’s known as ‘Z thumb,’ ” explained Bruno Lussiez, MD, during a virtual press conference organized by KeriMedical. Lussiez is the president of the French Society for Surgery of the Hand and is an orthopedic surgeon at the Medical and Surgical Orthopedic Institute of Monaco.
Rhizarthrosis affects significantly more women than men (8 of 10 cases). Most patients are between 55 and 75 years of age, although the condition also occurs in young, active people, Lussiez pointed out.
According to Benoit Augé, MD, a rheumatologist in Besançon, France, the first phase in managing rhizarthrosis can often be conducted by a general practitioner. He or she can perform an initial assessment and give first-line therapy, prescribing anti-inflammatory medications (when this is possible) and fitting the patient with an orthosis — a small supportive splint that prevents the thumb from moving and is quite useful during sleep. Kinesiotherapy may also be recommended.
“If these treatments aren’t providing enough relief, a rheumatologist can then be consulted. They may suggest injecting the affected area, for example, cortisone shots. If there’s a flare-up in, say, a year and a half, then another shot can be given. However, these treatments may only bring short-term relief. In that case, surgery may be the answer for patients seeking a more lasting solution,” said Augé. He went on to acknowledge, “But it’s true: not many people know that surgery has a place in treating rhizarthrosis.”
Surgery: A Little-Known Option
When it comes to rhizarthrosis, healthcare professionals often consider medical treatment, which is aimed at relieving pain, not at treating the osteoarthritis itself, to be the only solution. “The vast majority of cases can be managed in those first two phases: by a general practitioner and by a rheumatologist,” Augé stated.
When medical treatment isn’t proving to be enough, surgery should be presented as an option. “We frequently have patients who are unaware that rhizarthrosis can be operated on. They’re surprised to find out that it’s possible,” Lussiez said. “Yet this surgery has been around for 50 years, and in that time, French surgeons have been continuously working on enhancing and perfecting it.”
Three types of surgery are performed worldwide. The first involves removing a small bone in the wrist called the trapezium. “This is known as a trapeziectomy. It’s easy for the surgeon and it gets rid of the patient’s pain, but it doesn’t restore grip or pinch strength,” noted Laurent Obert, MD, PhD, head of the Department of Orthopedic and Plastic Surgery at the Besançon Regional University Hospital.
The second type of surgery, which is only used in special cases, immobilizes the thumb by fusing together two small bones.
In the third type of surgery, an articulating prosthesis is implanted, which effectively replaces the affected joint, similar to an artificial hip. This treatment eliminates the pain and restores the patient’s ability to grip or pinch with the index finger and middle finger. Most of the time, this operation is performed under local and regional anesthesia and takes about 45 minutes to an hour to complete. Because the pain is gone, patients recover useful function of their thumb very quickly, said Obert.
The most common complication is dislocation, which is when part of the prosthesis becomes displaced. But this is rare and does not happen with the latest state-of-the-art devices. Another common complication is wear, which varies depending on the patient’s use. The prostheses are made with new materials that have greatly improved durability.
“A thumb prosthesis is now an affordable solution that can get the patient back to having a pain-free thumb, a thumb that’s strong and stable when carrying out everyday manual tasks. And recovery time is a month and a half,” Obert pointed out.
“The thumb prostheses we use these days, one of two modern rhizarthrosis treatments that involve implants (another type of device that’s surgically placed), have excellent results in terms of quality — similar to those we see with prosthetic hips. Thanks to these prostheses, patients, especially younger patients, are able to quickly resume their activities at work and at play,” said Lussiez.
Launch of the Rhizarthrosis Informational Website
Set up by KeriMedical, this website has information for both the general public and healthcare professionals (eg, referring general practitioners, rheumatologists, radiologists, and kinesiotherapists). The goal is to give healthcare professionals the information they need to provide their rhizarthrosis patients with the best support and guidance when discussing possible individualized treatments. In addition to information about the latest research on thumb osteoarthritis and current treatments for the condition, the site features patient testimonials. It also provides reference documents, which can be downloaded for free. All visitors to the site — healthcare professionals, caregivers, and patients alike — can search the directory of hand surgeons trained in joint arthroplasty.
This article was translated from the Medscape French edition.