To better understand the load distribution in the Thumb Carpometacarpal Joint (CMC joint) in presence of osteoarthritis and how surgery by means of a suspension-resection arthroplasty or a joint replacement by means of a metal prosthesis affects this load distribution. These studies allow to supporting medical decisions and surgical treatments results with biomechanical evidence.The clinical management of the patients will be adapted to the treatment standards of the Orthopedic Surgery and Traumatology Service of the Hospital de la Santa Creu i Sant Pau, without the performance of this study influencing this process.
Primary Osteoarthritis in thumb CMC joint in the hand
Adults aged between 50 and 88 years old included.
Thumb CMC joint osteoarthritis, radiographic stages II, III and IV by Eaton- Littler classification (1973).
Asymptomatic primary osteoarthritis in thumb CMC joint
Patients with osteoarthritis and age less than 50 years or more than 88 years.
Patients who have had previous interventions in the area, in this joint, injuries in this hand or fractures.
Patients with rheumatic diseases or collagen diseases that create joint instability.
Adult patients with chronic pain and thumb CMC joint osteoarthritis that need surgical treatment.
Cohort
Prospective
Trapezectomy and carpometacarpal joint resection-supension arthroplasty
Procedure/SurgeryCarpometacarpal arthroplasty without implant: Trapezectomy and ligamentoplasty.
Trapeziometacarpal joint prosthesis
Procedure/SurgeryJoint carpometacarpal prostesis
Thumb carpometarcarpal joint radiological evaluation
Standard radiographs are required x-rays in posteroanterior (PA), PA in pronation (Robert´s view) and lateral views for assessment of the radiological stages of Eaton-Littler modified by Eaton-Glicker classification (1973). This classification include four stages of progression of the loss cartilage in thumb CMC joint, from I to IV. The X-rays will made in clinics at 6 weeks, 3 months, 6 months and 12 months after the surgical repair.
Thumb carpometacarpal joint CT scan evaluation
A Computed Tomography (CT) scan is also required for the initial evaluation and regular control of these patients. For each participant, CT scans will be perform in static limb positions before and after the surgery.
3D modeling and finite element methods of evaluation of the CT scan before and after surgical intervention.
In each patient will be performed with the computed specific software Epylisis and Ansys in Dimension Lab 3D, Hospital de la Santa Creu i Sant Pau by biomedical engineers. To obtain the 3D geometrical information for a subject-specific finite element human hand, CT images will take from patients. Each scan is recontructed in a Digital Imaging and Communications in Medicine (DICOM) format. These 2D data (DICOM data collection) are process using medical image processing software Mimics (Materialise, Leuven, Belgium). All the CT images will be segmented manually into the bones and skin, while subcutaneous tissues and tendons will be reconstructed based on CT images. A specific software (Epylisis, Ansys) will be used to simulated the loads in the thumb CMC joint. Epylisis is one of this specific software based on the Finite Element Methods (FEM), enables computational simulation of the biomechanical behavior of the trapeziometacarpal joint. It is used to conduct mechanistic analyses
Pain pre and postoperative
A Visual Analoge Scale (VAS) is used to assess pain (range, 0-10). This scale is from 0, no pain to 10, uncontrollable pain.
Pinch force pre and postoperative
A pinch Jamar dynamometer is used to measure pinch force, scale from 0-30 Kilograms (Sammons Preston, Bolingbrook, IL, USA).
Grip Strength pre and postoperative
A Jamar dynamometer is used to assess grip strength, scale from 0 to 90 Kilograms (Sammons Preston, Bolingbrook, IL, USA).
Range of motion
A goniometer is used to assess the thumb CMC range of motion (flexion, extension, adduction, abduction), measure in grades from 0-90º.
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