Wear and tear of the joint cartilage is a wear and tear of the joint cartilage that occurs insidiously, usually unnoticed at first. Wear and tear of the thumb saddle joint, also known as rhizarthrosis, can be very painful. In most cases, the cause is unknown and targeted therapy is not possible. If the cartilage protective layer is lost, the load is no longer dampened and evenly distributed.
Unfortunately, cartilage damage cannot be completely reversed to date. At the beginning, the forces acting on the joint can be buffered by special thumb splints. Ibuprofen, diclofenac or the vegetable frankincense extract H15 are frequently used because they have an anti-inflammatory and analgesic effect. If these measures no longer help, a surgical intervention can be useful. Which of the various surgical treatments (e.g. fat stem cell treatment, denervation, resection arthroplasty) is the right one for you depends on your requirements and the degree of wear and tear.
Resection arthroplasty is the procedure with the most experience. The worn large polygonal bone is removed via a small access on the outside of the ball of the thumb and the joint is stabilized with suture techniques.
Fat stem cell transplantation is a new minimally invasive treatment for joint wear. Stem cell therapy can be used as a curative treatment for minor joint degeneration in order to postpone a major intervention such as resection arthroplasty.
Treatment costs are not covered by health insurance. Nevertheless, the positive results of the self-fat treatment of rhizarthrosis established since 2014 are scientifically proven (Herold C, et al. Handchir Mikrochir Plast Chir. 2014 Apr;46(2):108-12. Erne HC, et al. Autologous Fat Injection versus Lundborg Resection Arthroplasty for the Treatment of Trapeziometacarpal Joint Osteoarthritis. Plast Reconstr Surg. 2018 Jan;141(1):119-124. Herold C, et al. Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Study. Plast Reconstr Surg. 2017 Aug;140(2):327-335.). As a rule, pain relief and functional improvement can be expected for at least 12 months.
The cells can be gently aspirated from the abdomen, thighs, buttocks or knees. The suctioned fat tissue is cleaned and filtered several times. The cells are then injected into the thumb saddle joint. The stem cells from the fat tissue can develop into cartilage cells. In addition, the cells can lead to an improvement of the synovial fluid.
- All your questions about possible complications and alternative treatments should be answered in advance.
- Keep nicotine and alcohol consumption to a minimum!
- Blood-thinning medication (e.g. ASS, Thomapyrin®) must be discontinued at least 10 days before the operation after consultation with your doctor.
- Vitamin preparations (A, E) and food supplements (omega-3 fatty acids, St. John's wort preparations, etc.) must be discontinued at least 4 weeks before the operation.
- Surgery limits the ability to travel by air. Therefore, do not plan any professional or private air travel during the 6 weeks after the operation!
- Lay down ice cubes or cooling pads at home ready to cool the skin after the operation!
- The raising and cooling of the hand in the first 72 hours is very important.
- Immobilization is recommended for a total of 4 weeks (Palmare forearm wrist thumb splint with free interphalangeal joint in opposition and abduction of the thumb for 14 days; then middle hand thumb splint with release of the interphalangeal joint for a further 14 days).
- Complete fist closure and finger stretching exercises should be performed several times per hour. All joints outside the splint must be fully moved several times an hour.
- A silicone capillary drainage is removed on the 1st postoperative day if necessary, the skin threads are removed after 10 to 14 days.
- Postoperative clinical check-ups are recommended on the 1st and 3rd postoperative day and after 1 and 2 and 4 weeks.
- The independent scar massage from the 3rd postoperative week with moisturizing ointment (e.g. Bepanthen® wound and healing ointment, Linola® fat cream) helps to create inconspicuous soft scars.
- A full load is possible from the 12th postoperative week.