Osteoarthritis Thumb
Conditions
Brief summary
Patients with thumb carpometacarpal joint osteoarthritis usually suffer from pain, joint enlargement, inflammation, deformity and loss of function. Conservative treatments usually are the first-line interventions, unfortunately some of the patients do not response to such treatments and surgical treatment will then be considered. Compare to other traditional surgical techniques, arthroscopic techniques has resulted in the potential to treat osteoarthritis in a minimally invasive approach, avoiding the need for a larger incision. Other advantages of arthroscopy include less scarring and joint contracture, less risk of neurovascular injury, improved appearance, limited morbidity and quicker recovery. Although arthroscopic methods have been proved to be effective, there is lack of high-level evidence based studies to conclude one operation is superior to another. Hence, this study is designed to investigate outcomes of the two arthroscopic surgical methods (arthroscopic debridement vs arthroscopic hemi-trapeziectomy with Mini TightRope). The result of this study is expected to provide significant evidence based clinical data for surgeons worldwide on treating the thumb carpometacarpal joint osteoarthritis.
Interventions
PROCEDUREArthroscopic Debridement
Arthroscopic debridement will be performed under portal site local anaesthesia.
PROCEDUREArthroscopic Hemi-Trapeziectomy with Mini TightRope
Anaesthesia, position and arthroscopy will be performed in the same way as for arthroscopic debridement, except the distal part of the trapezium will be resected to a depth of 3-4mm together with protruding osteophytes.
Sponsors
Chinese University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcomes assessor and biostatistician will be blinded
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with Eaton and Glickel stage II and III of thumb carpometacarpal joint osteoarthritis * Age≥18 years old * Failed to response to nonsurgical/conservative treatments including orthoses/splinting, activity modification, oral analgesics (e.g. nonsteroidal anti-inflammatory drugs), strengthening/flexibility exercises, and injections of corticosteroid or hyaluronic acid * Willing to receive surgery
Exclusion criteria
* Patients received previous thumb surgery proximal to the interphalangeal joint (IPJ) * Patients with prior traumatic thumb injuries (e.g. fracture, dislocation) * Patients with significant metacarpophalangeal joint (MCPJ) pain * With concurrent procedures on the thumb, e.g. ganglion removal, trigger thumb release
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual Analogue Scale (VAS) Pain Score at Rest and Exertion | Pre-operative | Pre-operative VAS pain score at rest and exertion will be measured |
| Short-Form Survey (SF-36) | Pre-operative | Generic health status instrument to assess quality of life |
| Disability of Arm, Shoulder and Hand (DASH) questionnaire | Pre-operative | Specially designed tool to assess upper extremity disability and symptoms |
| Patients' Satisfaction Score | Pre-operative | To grade the subjects' satisfaction regarding to their thumb conditions (0=totally not satisfied; 10=fully satisfied) |
| Grip Strength | Pre-operative | Will be measured in kg |
| Key and Tip Pinch | Pre-operative | Will be measured in kg |
| Range of Motion (ROM) | Pre-operative | ROM of interphalangeal joint and metacarpal joint of thumb will be measured |
| Kapandji Score | Pre-operative | A tool for assessing the opposition of the thumb |
| Complications | Post-operative up to 2 years | Any complications related to the surgery will be documented |
Countries
Hong Kong
Contacts
Primary ContactChu Kay Michael Mak, FRCSEd(Orth)
Backup ContactWai Ping Fiona Yu, MPH
Outcome results
None listed