new basal joint arthritis · 2015. 10. 5. · didier&fontÈs&...
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Didier FONTÈS (Sports Clinic of Paris – France)
BASAL JOINT ARTHRITIS -Arthroscopic interposition-
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Instrumentation
§ Trac;on Tower (Whipple) or shoulder holder
Stabiliza)on of the forearm (assistant)
Single thumb finger trap (2-‐4 Kg trac)on)
§ Mini-‐fluoroscopy for Xray control
§ Short-‐barrel op;cal : Smooth trochart Diameter : 1,9 mm or +
§ Specific miniaturized instruments : Probes, dissectors, graspers, baskets … Power Shavers and burs Radiofrequency abla)on probe (mini VAPR)
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Technique • Loco-‐regional anaesthesia • Tourniquet • Outpa)ent surgery • Thumb trac)on (2-‐4 kg)
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Surgical Anatomy (CMC joint)
§ Portals : 1R, 1U +/-‐ thenar portal Pay aSen)on to superficials nerves,
radial artery, tendons
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Surgical Anatomy (CMC joint)
A.I. Kapandji
§ Extrinsic ligaments : Controversial physiology (up to 17 have been described)
§ Car)lages & bones: Double saddle joint
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Diagnostic Arthroscopic CMC Examination
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Basal Joint Arthritis n Diagnosis Ao (Badia’s Ao classifica)on) : n Evalua)on of chondromalacia n Ligaments laxity associa)on
Grade 1
Grade 2
Grade 3
Eaton
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Badia’s treatment Algorithm
Ao interposi;on
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The surgical procedure
• Explora)on, Evalua)on, Washing • Debridement (removal foreign bodies) • Shrinkage • (+/-‐ Par)al trapezectomy) • Interposi)on arthroplasty (PLA device or palmaris longus)
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The surgical procedure
• Explora)on, Evalua)on, Washing • Debridement (removal foreign bodies) • Shrinkage • (+/-‐ Par)al trapezectomy) • Interposi)on arthroplasty (PLA device or palmaris longus)
Shrinkage is not cooking !
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The surgical procedure
• Explora)on, Evalua)on, Washing • Debridement (removal foreign bodies) • Shrinkage • (+/-‐ Par)al trapezectomy) • Interposi)on arthroplasty (PLA device or palmaris longus)
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The surgical procedure
• Explora)on, Evalua)on, Washing • Debridement (removal foreign bodies) • Shrinkage • (+/-‐ Par)al trapezectomy) • Interposi)on arthroplasty (Palmaris longus or PLA device)
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The surgical procedure
• Explora)on, Evalua)on, Washing • Debridement (removal foreign bodies) • Shrinkage • (+/-‐ Par)al trapezectomy) • Interposi)on arthroplasty (Palmaris longus or PLA device)
ARTELON®
No more used: foreign bodies rxns
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The surgical procedure
• Explora)on, Evalua)on, Washing • Debridement (removal foreign bodies) • Shrinkage • (+/-‐ Par)al trapezectomy) • Interposi)on arthroplasty (Palmaris longus or PLA device)
PLA AREX®
No more marketed
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The surgical procedure
• Explora)on, Evalua)on, Washing • Debridement (removal foreign bodies) • Shrinkage • (+/-‐ Par)al trapezectomy) • Interposi)on arthroplasty (Palmaris longus or PLA device)
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Polylactic Acid Implant
§ Bio absorbable polymer deriva)ve of natural components (sugar + corn)
§ PLA is used in aesthe)c medicine and surgery (anchors, sutures, stents…)
§ In Vitro and in Vivo studies concluded to: § Good tolerance § Few reverse effects (loose bodies reac)ons)
§ Progressive fibro-‐collagenous coloniza)on
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Experience in Basal Joint or Foot Arthritis Open surgery (RegJoint®)
• Over 5 years of clinical experience • More than 300 pa)ents operated
• Very good outcomes
• No loose bodies adverse reac)ons
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The introduction of the device
04/02/12 10:55
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POST-OP Care
• No K wires, no suture, comfort splint, self rehabilita)on
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Results of Arthroscopic Interposition Arthroplasty
Simple technique with numerous advantages
• No bone perfora;on
• No trapeziectomy
• No K-‐wires
• Realignment of M1/ ligaments tensioning
• Not expensive
• Fast recovering
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Conclusion
• Mini invasive reliable non irreversible procedure • Place to find beside total trapezectomy and prosthesis
• Obvious interest of arthroscopic explora)on, grading and debridement
• Larger follow-‐up will be necessary to confirm these encouraging results