The patient has basal joint arthritis of the thumb and randomized controlled trials have failed to demonstrate an advantage of steroid or hylan over saline.
Heyworth et al demonstrated that all three injections were similarly effective for approximately 3 months at reducing pain and increasing thumb function over baseline levels.
Stahl found that steroid and hylan were equally effective, but did not control with saline.
Henderson found no advantage of hyaluronan over saline for knee arthritis during a 5 week treatment course.
Joint Replacement/Arthroplasty. Not everyone is a candidate for a fusion, so there is a role for this surgery. Even though it is called a “joint replacement” surgery, there is no actual implant unlike a knee or hip replacement, for example. The thumb moves in too many different planes that there is no device currently on the market that can accommodate the high stresses and range of motion that the thumb undergoes. Instead, Dr. Viola uses an APL to FCR tendon transfer technique to stabilize the base of the thumb after removing the arthritic trapezium articulation to the 1st metacarpal (that was causing the bone-on-bone pain). Post-operatively, patients are casted or splinted and given fairly strict use restrictions for six weeks. Motion of the fingers, tip of the thumb and forearm are allowed during this time (unlike every joint in the hand except the base of the thumb in the fusion surgery).