Perioperative management - Resection-Suspension Arthroplasty according to Epping for Rhizarthrosis

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Authors

Dr. med. Kirsten Beyermann

Fachärztin für Chirurgie, Unfallchirurgie, Handchirurgie

Date

Indications
- Pain
- Failed conservative therapy
- Radiologically proven advanced thumb carpometacarpal joint osteoarthritis
Staging of rhizarthrosis according to the clinical pain symptomatology according to Alnot and Saint Laurent
Stage 0
No complaints
Stage I
Pain during certain activities
Stage II
Pain during everyday activities
Stage III
in addition to Stage II, episodes of rest pain
Stage IV
(almost) constant pain
Contraindications
- Local or general conditions that surgically or anesthesiologically contraindicate an elective operation or are preoperatively improvable

Preoperative Diagnostics

Clinical Examination:
- Inspection/Palpation of a painful thickened saddle joint with crepitation
- in advanced cases, adduction contracture of the 1st CMC joint with hyperextension of the MCP joint (so-called 90/90 deformity)
X-ray examination in 2 planes

(CMC joint = Carpometacarpal joint, MCP joint = Metacarpophalangeal joint)

Radiological Classification of Rhizarthrosis according to Eaton and Littler

Stage I	Normal, possibly widened joint space (effusion), slight subluxation of the metacarpal bone I
Stage II	Slight joint space narrowing, osteophytes smaller than 2 mm, pronounced subluxation of the metacarpal bone I
Stage III	Pronounced joint space narrowing up to elimination of the joint space, osteophytes larger than 2 mm
Stage IV	Joint destruction, cystic, sclerotic remodeling processes, pronounced subluxation of the metacarpal I, STT arthrosis

(STT joint = Scapho-trapezo-trapezoidal joint)

Special Preparation
- no special preparation of the patient necessary
- basically outpatient procedure
- Assessment of contraindication for bloodless field (e.g. existing shunt in dialysis)
Informed Consent
Informed consent about
- surgical method
- extension procedures such as e.g. reconstruction radial artery, nerve, tendon
- general surgical risks
  wound healing disorder
  tendon injury
  functional deficit wrist/hand
  CRPS = Sudeck's disease
- specific surgical risks
  Injury to superficial branch of radial nerve or medial antebrachial cutaneous nerve with neuropathic pain
  Injury to radial artery
  Injury to FCR tendon with weakening of wrist flexion
  Injury to base of metacarpal I during bone drilling
  reduction in grip strength
  protracted scar pain (usually subsides after 6 months)
  persistent complaints
  revision surgery
  risk of recurrence

Anesthesia

intravenous regional anesthesiaplexus anesthesiageneral anesthesia ... - Operations in general, vis

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After activation, you can expect the following content:

Stage 0	No complaints
Stage I	Pain during certain activities
Stage II	Pain during everyday activities
Stage III	in addition to Stage II, episodes of rest pain
Stage IV	(almost) constant pain