S. I. Noorbakhsh1, J. Enoch2, W. T. McClellan1, 2 1West Virginia University School of Medicine, Morgantown, WV, USA 2McClellan Plastic Surgery, Morgantown, WV, USA
Introduction:
Basilar thumb arthritis occurs at the carpometacarpal (CMC) joint. Diagnosis is clinical, but the Eaton classification (I-IV) is a radiographic scale used to grade severity. Patients with severe or refractory disease are often treated surgically. Though operative treatments involving trapeziectomy have been shown to be effective for pain reduction in aggregate, results are variable, outcomes are often short-lived, and permanent alteration to the anatomy of the thumb base may lead to decreased function. A potential minimally invasive alternative to trapeziectomy-based surgery for treatment of basilar thumb arthritis is intra-articular fat grafting.
Methods:
A total of 18 cases of basilar thumb arthritis were prospectively treated with intra-articular fat grafting. In each case, fluoroscopy was used to clearly identify the joint space. “Disability of the Arm, Shoulder, and Hand” (DASH) score (0-100) was assessed pre-operatively and at 1 month, 6 months, and 12 months post-operatively. Average DASH scores were compared over time, and t-tests were used to assess statistical significance.
Results:
Average pre-operative pain score was 8.00 (SD 1.33) on a 10-point scale. Eaton stage was available in 14 of the 18 cases: 5 stage II, 5 stage III, and 4 stage IV. Average pre-operative DASH score was 52.15 (95% CI: 43.94 to 60.36; n=18). Average post-operative DASH scores were 21.80 (95% CI: 15.86 to 27.74; n=15) at 1 month post-operatively, 18.91 (95% CI: 10.88 to 26.94; n=11) at 6 months post-operatively, and 26.88 (95% CI: 17.58 to 36.18; n=16) at 12 months post-operatively (Table 1). Average improvement in DASH score from pre-operative baseline following fat grafting was 30.35 (95% CI: 19.39 to 41.28; p= 0.001) at 1 month post-operatively, 33.24 (95% CI: 20.39 to 46.07; p= 0.001) at 6 months post-operatively, and 25.27 (95% CI: 12.41 to 38.11; p= 0.003) at 12 months post-operatively (Table 1).
Conclusion:
The DASH score has been validated as a longitudinal scale to assess upper extremity disability, with a 10-point difference found to be clinically significant. In this study, DASH score improvements after intra-articular fat grafting for the treatment of basilar thumb arthritis were both statistically and clinically significant at 1, 6, and 12 months post-operatively, representing a significant increase in upper extremity functionality. Our data are consistent with findings of a 2017 small prospective study conducted by Herold et al. These data indicate that further higher-powered studies to directly compare autologous intra-articular fat grafting to trapeziectomy-based surgery for the treatment of basilar thumb arthritis are indicated.
