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Home / Total Joint Arthroplasty in the Treatment of Advanced Stages of Thumb Carpometacarpal Joint Osteoarthritis

Total Joint Arthroplasty in the Treatment of Advanced Stages of Thumb Carpometacarpal Joint Osteoarthritis

Posted on May 1, 2000 by Badia Hand to Shoulder Center

Total Joint Arthroplasty in the Treatment of Advanced Stages of Thumb Carpometacarpal Joint Osteoarthritis

April 12, 2007 

Author:  Alejandro Badia, MD, S.N. Sambandam, MS
Download Article: CMC_JHS06.pdf

 

Purpose
Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women. Many different surgical techniques have been proposed for extensive degenerative arthritis of the first carpometacarpal (CMC) joint. Joint replacement has been an effective treatment of this condition. The purpose of this article is to present the outcome of a total cemented trapeziometacarpal implant in the treatment of more advanced stages of this disease.

Methods
Total joint arthroplasty of the trapeziometacarpal joint was performed on 26 thumbs in 25 patients to treat advanced osteoarthritis (Eaton and Littler stages III and IV) between 1998 and 2003. Indications for surgery after failure of conservative treatment were severe pain, loss of pinch strength, and diminished thumb motion that limited activities of daily living. A trapeziometacarpal joint prosthesis was the implant used in this series. The average follow-up time was 59 months.
Results: At the final follow-up evaluation, thumb abduction averaged 60° and thumb opposition to the base of the small finger was present. The average pinch strength was 5.5 kg (85% of nonaffected side). One patient had posttraumatic loosening, which was revised with satisfactory results. Radiographic studies at the final follow-up evaluations did not show signs of atraumatic implant loosening. One patient complained of minimal pain, and the remaining 24 patients were pain free.
Conclusions: In our series, total joint arthroplasty of the thumb CMC joint has proven to be efficacious with improved motion, strength, and pain relief. We currently recommend this technique for the treatment of stage III and early stage IV osteoarthritis of the CMC joint in older patients with low activity demands. (J Hand Surg 2006;xx:xxx. Copyright © 2006 by the American Society for Surgery of the Hand.)
Type of study/level of evidence: Therapeutic, Level IV. Key words: Carpometacarpal, cemented arthroplasty, osteoarthritis, thumb

The trapeziometacarpal joint has an exclusive anatomic design that allows arcs of motion in 3 different planes (abduction–adduction, flexion– extension, axial rotation) to place the thumb in a preaxial position to resist axial loads.1 These variable positions of load may explain why it is common for this joint to develop osteoarthritis (OA) even when other small joints in the vicinity remain uninvolved.2 It has been shown that there is a strong correlation between basal joint laxity (specifically volar ligament instability) and the evolution of early degenerative changes. These alterations lead to pain, weakness, and adduction deformity.3 Restoration of thumb function with a painfree, stable, and mobile joint with preserved strength are the main goals of treatment of painful arthritis of the thumb.2 Many surgical methods have been proposed to achieve these goals. Procedures such as ligament reconstruction,4–12 ligament reconstruction and tendon interposition,7,8,13–20 tendon interposition without ligament reconstruction,7,14,21–31 and simple trapezial excision7,8,32–35 all are associated with some loss of thumb length and hence pinch strength. The role of metacarpal osteotomy is not clearly established. 6,36–41 Arthrodesis is associated with loss of mobility and a transfer of reaction forces to the neighboring joints.29,42–48 Silicone implant arthroplasty was proposed as an alternative but is associated with instability, silicone wear, synovitis, prosthesis fracture, and prosthesis subluxation.35,49–64 Total joint arthroplasty was first described by de la Caffiniere and Aucouturier.65 This procedure applies the concept of total hip replacement to creating a permanent swivel within the base of the thumb that obviates the need for ligament reconstruction, replaces the joint surface with a mechanical bearing surface for frictionless movement, and provides stability for strong pinch and grasp.66 Various implant designs are available on the market for total joint arthroplasty of the thumb.36,65–85 The de la Caffiniere implant is the most widely used and most extensively studied implant65,69,70,73–76,78,80 – 83 Appendix 1 can be viewed at the Journal’s Web site, http://www. jhandsurg.org). De la Caffiniere first reported his own experience with this implant in 197965 and later in 1991.75 GUEPAR is another implant that has been reported in the French67,85,86 and German84 literature (Appendix 2 can be viewed at the Journal’s Web site, http://www.jhandsurg.org). Even though surgeons in different parts of the world continue to use other implants (Appendix 3 can be viewed at the Journal’s Web site, http:// www.jhandsurg.org), the indications and longterm outcomes of those implants are not reported frequently and hence are not adequately established. The Braun-Cutter prosthesis (SBI/Avanta Orthopaedics, San Diego, CA) is a commonly used implant for total joint arthroplasty.36,71,72 In his study71 in 1982, Braun reported his experience in 22 patients with 29 involved thumbs. Three years later, he reported his experience with 50 patients.36 These are the only 2 reports regarding the Braun prosthesis, both from its designer. The implant design, cementing techniques, and surgical techniques, however, have changed considerably in the past 20 years. Therefore, the purpose of this article is to report our experience with the Braun-Cutter trapeziometacarpal joint prosthesis and its outcome in the treatment of stage III and select cases of stage IV OA of the thumb carpometacarpal (CMC) joint.

Materials and Methods
Total joint arthroplasty of the trapeziometacarpal joint was performed on 26 thumbs in 25 patients (24 women, 1 man) to treat advanced basal joint OA of the thumb between 1998 and 2003 (Table 1). All patients were initially treated conservatively with nonsteroidal anti-inflammatory medications, splinting, and steroid injections for a minimum of 6 to 12 weeks. Surgical treatment was considered in those patients for whom the conservative treatment had failed and who continued to have severe pain, loss of pinch strength, and lack of thumb motion that limited their activities of daily living. Before surgery, we measured pain using a visual analog scale, movement using a goniometer, grip strength using a dynamometer (Jamar Digital Hand Dynamometer; Therapeutic Equipment Corp., Clifton, NJ), and pinch strength using a pinch gauge (Preston pinch gauge; JA Preston, New York, NY). Radiographic assessment was performed according to the Eaton-Littler method. Patients with Eaton stage III trapeziometacarpal arthritis87 and selected stage IV patients with clinically painless mild scaphotrapezial joint involvement were included in this study. Patients with clinically painful scaphotrapezial joints and those who had advanced radiologic osteoarthritic changes in the scaphotrapezial joint were excluded from having total joint arthroplasty of the thumb CMC joint. We also excluded patients who were younger than 60 years old or whose jobs involved strenuous manual work, because we believed that more active patients are not good candidates for implant arthroplasty.

Demographics
The average patient age was 71 years; there were 24 women and 1 man. There was 1 bilateral case. The right thumb was involved in 17 patients and the left in 9. The dominant hand was involved in 22 cases and the nondominant in 4. None of the patients had had previous thumb surgery. Most patients complained of diffuse pain about the thumb basal joint (visual analog scale score, 8–9/10) and decreased lateral pinch strength and grip strength. One patient had severe loss of the first web space. Patients experienced symptoms an average of 3 years (range, 1–4 y) before surgery. Positive physical findings included a grind test in all patients. Consistent preoperative radiographic findings were dorsal metacarpal subluxation, the presence of prominent marginal osteophytes on the ulnar border of the distal trapezium, joint space narrowing, cystic changes, and sclerotic bone (Fig. 1). No patients had severe flattening or loss of trapezial height of the trapezium, which would preclude the use of a CMC implant. Based on radiographic staging, 21 thumbs showed evidence of Eaton stage III OA and 5 of stage IV OA. Additional procedures performed at the time of CMC arthroplasty included endoscopic carpal tunnel release (8 patients), volar capsulodesis of the first metacarpophalangeal joint (4 patients), first extensor compartment release (6 patients), and first web space Z-plasty (1 patient). The average follow-up time was 59 months (range, 26–68 mo). During the follow-up visits, pain (visual analog scale), motion, pinch and grip strengths, and x-ray appearances of the individual patients were personally evaluated. No patient was lost to follow-up study. Surgical Technique The Braun-Cutter trapeziometacarpal joint prosthesis was implanted in this series by using a bone cement technique. A 3-cm, longitudinal, lazy-S incision is performed over the dorsal aspect of the base of the thumb. Branches of the superficial sensory radial nerve are identified and protected. Further dissection is performed between the extensor pollicis longus and extensor pollicis brevis tendons isolating and protecting the dorsal branch of the radial artery. The dorsal capsule of the trapeziometacarpal joint is opened longitudinally with a proximal-based flap. The periosteum and the dorsal capsule are reflected proximally as a single flap to be repaired later. A sagittal saw is used to remove the proximal 6- to 8-mm base of the thumb metacarpal. The adductor pollicis is released if required to allow abduction of the thumb metacarpal away from the palm. At this point, longitudinal traction and flexion are applied to better expose the trapezial surface. A rongeur is used to remove the marginal osteophytes and flatten the joint surface of the trapezium. With imaging, the center of the trapezium is identified with a small burr. The center hole is then enlarged to create a deep channel within the trapezium where the polyethylene cup will be cemented. For the thumb metacarpal, a guide is used to open the intramedullary canal, which is broached with a burr to allow for an ample cement mantle. The trapezial cup is first cemented in the trapezium (Fig. 2) with care taken to impact the cement beneath the subcortical bone. Once the cup has been inserted and the cement cured, the thumb metacarpal component is inserted with bone cement (Fig. 3). Because this stem is collarless, it is important to maintain adequate neck length (to prevent subsidence) until the bone cement has cured. Care is taken so that the stem neck does not impinge on the edge of the trapezium. Once the components are implanted and the cement has hardened, the stem is pressed into place in the cup on the trapezium. Stability and circumferential motion are assessed to ensure no impingement on the implant (Fig.4). The proximal-based capsule– periosteum flap is closed with absorbable suture. During the procedure, intraoperative fluoroscopy is performed to check proper alignment and placement of the prosthesis (Fig.5). We close the skin and the subcutaneous tissue with a resorbable suture and apply a well-padded short-arm thumb spica splint with the thumb in opposition for 1 week, after which rehabilitation is started. An orthoplast thumb-based spica splint is applied for further protection when thumb exercises are not performed. Patients rapidly regain thumb–to– base of small finger opposition with an active and gentle active assisted range-of-motion (ROM) protocol. Clinical Assessment Follow-up assessments of the patients were performed by an independent examiner who had not been involved in either the surgical procedure or patient care. A VAS was used to assess the pain level (0, absence of pain to 10, severe pain). The frequency of pain was also registered (never, occasional, frequent, constant). The grip strength was determined with a dynamometer (Jamar Digital Hand Dynamometer) and lateral pinch strength was determined with a pinchmeter (Preston pinchmeter). Complete interphalangeal and metacarpophalangeal joint ROMs and radial abduction were recorded with a goniometer. The ability to oppose the thumb to the base of the small finger was recorded as the distance from the thumb distal pulp to the fifth metacarpal head. An objective assessment was performed with the Buck- Gramcko score.
Radiologic Evaluation Posteroanterior and lateral radiographs were obtained at the final follow-up evaluations to evaluate cup migration, stem subsidence, zones of osteolysis, and joint subluxation as defined by Wachtl et al.

Results Clinical Assessment Pain relief. Complete pain relief was achieved in 24 patients (96%). Mild pain was present in 1 patient after traumatic injury to the hand. A revision of the prosthesis was required for secondary loosening believed to be caused by the injury. Strength. The preoperative pinch strength was 6.0 kg in the noninvolved side and 3.5 kg in the affected thumb (61% of the contralateral side). The postoperative pinch strength was 6.5 kg in the noninvolved side and 5.5 kg in the affected one (85% of the contralateral side). Mobility. The final thumb radial abduction was 60° (range, 50°– 65°). Palmar abduction was more than 40° in all patients, and all patients were able to comfortably hold large objects between the thumb and index finger. Flexion and extension were not quantified but were satisfactory at the final follow-up examination. The final ROM of the metacarpophalangeal joint was 5°– 40°, and thumb opposition reached the base of the small finger in all cases. Loosening analysis. Radiographic studies at the final follow-up evaluation showed no evidence of implant loosening, cup migration, stem subsidence, or subluxation in either the anteroposterior or lateral views of the thumb (Fig. 6). This was also the case for the 1 patient in the series who had revision surgery performed. Survival analysis. There was only 1 revision (96% survival) in our series, performed in a woman who fell after the primary replacement and dislocated the components. Closed reduction was obtained, and a thumb spica splint was used. Even though the patient’s ROM continued improving she had mild discomfort, and 3 years after the original procedure she had revision surgery using the same type of prosthesis for posttraumatic loosening. At the final follow- up examination (5 years), she did not have any pain and radiographic findings were the same as for patients who did not have revision surgery. Objective assessment. We used the Buck-Gramcko score in this study to objectively assess the outcome. The mean total in our series was 53 points (range, 47–54), constituting an excellent outcome (Appendices 4, 5) can be viewed at the Journal’s Web site, http://www.jhandsurg.org). There were 24 excellent results, and the patient who required revision of her joint had good result (47 points ) after the revision surgery.

Discussion
Restoration of thumb function ideally should provide pain-free, stable motion at the basal joint with adequate strength and proper balance of the entire ray. In this study, we reported good to excellent results after total joint cemented arthroplasty with the Braun-Cutter implant) for the treatment of CMC OA in select patients. Twenty-four patients in our series had an excellent outcome, and 1 had a good outcome based on the Buck-Gramcko score. Complete pain relief was achieved in 24 patients (96%), and the average strength was 85% of that on the unaffected side. Implant survival was 96% in our study. The only complication seen in our series was an implant dislocation due to trauma in 1 patient that later required revision surgery because of pain and posttraumatic loosening. No spontaneous loosening was found. Fracture or dislocations of the prosthesis and posttraumatic loosening have been reported by few other researchers in the past. In 1985 Braun36 reported 2 cases of posttraumatic loosening that required revision surgery. Complications such as asymptomatic or symptomatic loosening,36,65,66,69,70,71,82,83 heterotropic ossification,36,66,71 cement extrusion with tendon and nerve injury,36 or reflex sympathetic dystrophy36 were not seen in our series. Various surgical procedures have been described for stage III and early stage IV OA of the thumb CMC joint. The literature specifically regarding trapeziometacarpal total joint arthroplasty is rather limited, and the indications are not clearly delineated. The de la Caffiniere implant is the most widely used and most extensively studied implant65,69,70,73– 76,78,80 – 83,91 (Appendix 3). The GUEPAR is another implant that has been reported in the French67,85,86 and German84 literature. Even though surgeons in different parts of the world continue to use other implants, the indications and long-term outcomes of those implants are not reported frequently and hence are not adequately established. In 1979, de la Caffiniere and Aucouturier65 reported their experience with a total CMC prosthesis with 34 thumbs in 29 patients with an average follow-up period of 2 years. That series included patients with both OA and rheumatoid arthritis of the thumb. There were 5 cases of radiographic loosening, but the functional results remained adequate and these were not revised. Other researchers have reported similarly good results with the de la Caffiniere prosthesis (Appendix 1). The only exception was the report by Wachtl33 in 1998. He reported his extensive experience in 84 patients with 88 thumbs involved. Implants required revision surgery in 10 cases with an overall survival rate of 66%, and asymptomatic loosening was detected in 52%. The reasons for his poor results were not clearly evident, but the average age of patients in his series was 61 years. He did not report the activity levels of his patients. Further, he mentioned revision surgery for loosening but failed to mention whether his patients were symptomatic or not. Recently, De Smet et al76 reported their experience with the de la Caffiniere prosthesis with 43 thumbs in 40 patients with an average of 26 months of follow-up evaluation.

There was no revision surgery in that series, but lucent zones appeared in 44% (most of them occurring in patients younger than 60 years old); progression to clinical loosening was not reported. The Braun prosthesis has been less extensively studied. Braun reported his initial experience in 22 patients in 198271 and later in 50 patients in 1985.36 In the initial report he had to revise 3 cases, and later in the larger series 4 implants required revision surgery. Braun believed that revision is possible in the context of implant failure because of the well-preserved bone stock. There have been no reports by unbiased surgeons on the outcomes with use of this particular implant. We believe that the appropriate selection of patients for this procedure is an important factor determining the outcome. Trapeziometacarpal total joint arthroplasty is most commonly indicated for late Eaton-Littler stage II and stage III OA. It is important to determine if scaphotrapezial-trapezoidal joint involvement will influence the decision of whether to use an implant, which obviously requires trapezial preservation. North and Eaton92 found that 47% of cadavers had scaphotrapezial joint arthritic changes along with trapeziometacarpal joint arthritis and suggested that routine complete trapezial excision was not necessary. Several researchers68,81 included patients with moderate scaphotrapezial joint involvement in their arthroplasty series and concluded that involvement of the scaphotrapezial joint is not a contraindication for total joint implant arthroplasty of the thumb trapeziometacarpal joint. Our clinical experience has also suggested that certain early stage IV cases are amenable to this method of treatment. We clinically assessed the scaphotrapezial-trapezoidal joint by direct palpation of the joint dorsally. A painful scaphotrapezial-trapezoidal joint was considered a contraindication to this procedure, as were advanced radiographic changes in this joint. Few reports78,84 have highlighted the importance of trapezial height for good surgical outcome in total joint arthroplasty. With this in mind, we excluded those patients with advanced radiographic OA changes of the scaphotrapezial joint with a wedgeshaped trapezium. We believe this factor might have also contributed to the favorable outcome achieved in our series. Accurate implant design plays a vital part in developing a dependable and successful system. Different implant designs have been developed in the past. The Braun-Cutter design (SBI/Avanta Orthopaedics) consists of a metallic metacarpal component articulated with a polyethylene cup trapezial component. The form and length of the metacarpal component of the Braun-Cutter prosthesis allows for central placement at an appropriate depth in the medullary canal. Subsidence of this titanium metacarpal component is prevented by 3 transverse troughs strategically located on the stem of the implant. The conical implant shape and porous coated surface provides a good cement–prosthesis interface. The ultra-high– molecular-weight polyethylene of the trapezium component has a cylindric outer shape that resembles a champagne cork and permits pressurization of the cement and proper positioning. Once implanted, the articulated components lie at the normal anatomic level of the trapeziometacarpal joint, which promotes appropriate muscle balance in the thumb. Furthermore, the relation between the neck diameter of the metacarpal component and the open surface and cup walls allows for unrestrained rotation and nearly 90° of motion in any direction without impingement. Apart from implant design, other possible factors responsible for good outcome are appropriate component alignment, proper cementing techniques, and addressing the hyperextension of the thumb metacarpophalangeal joint and metacarpal adduction.66 In our series, we revised the implant in only 1 patient. The reason for revision in this case was posttraumatic loosening with a painful joint. This is in contrast to previous studies36,65,66,68,69,70,71,73,76,77,81– 83 in which the most common indication for revision was symptomatic nontraumatic loosening. The sole patient who had revision surgery in our series had a satisfactory result. Total joint arthroplasty has been shown to give better or comparable functional results compared with other surgical procedures performed for advanced trapeziometacarpal joint OA. Apart from the comparable functional results, another important benefit it offers to patients is rapid recovery and the need for minimal rehabilitation. The constrained design principle obviates the need for prolonged immobilization, because soft-tissue and capsular healing are not critical for implant function. This key element cannot be overemphasized, because most of our patients were elderly patients who lived alone and required rapid recovery to continue living independently. Many had physical difficulty getting to the therapy sites. We believe this particular aspect contributed to the high level of satisfaction seen in our patient group. All patients, including the one who had revision surgery, were happy with the outcome and indicated they would have the same procedure performed the other thumb if the need arose. We recognize that there are some shortcomings to this study: The study is a prospective, noncomparative study without any control group. Furthermore, this study was performed on a selected subset of patients who were over 60 years of age and were low-demand patients and who had stage III or early stage IV OA of the thumb basal joint. We believe this is the group of patients who would most benefit from this procedure while maximizing success with an implant.

Received for publication August 30, 2004; accepted in revised form August 9, 2006. The Journal of Hand Surgery / Vol. 31A No. 9 November 2006 No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Corresponding author: Alejandro Badia, MD, FACS, Hand, Upper Extremity and Microsurgery, Miami Hand Center, 8905 SW 87th Ave, Ste 100, Miami, FL 33176;e-mail: alex@surgical.net Copyright © 2006 by the American Society for Surgery of the Hand 0363-5023/06/xx0x-0001$32.00/0 doi:10.1016/j.jhsa.2006.08.008
References 1. Kuczynski K. Carpometacarpal joint of the human thumb. J Anat 1974;118:119 –126. 2. Barron OA, Glickel SZ, Eaton RG. Basal joint arthritis of the thumb. J Am Acad Orthop Surg 2000;8:314 –323. 3. Pelligrini VD Jr. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. II. Articular wear patterns in the osteoarthritic joint. J Hand Surg 1991;16A:975–982. 4. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg 1984;9A:692–699. 5. Freedman DM, Eaton RG, Glickel SZ. Long-term results of volar ligament reconstruction for symptomatic basal joint laxity. J Hand Surg 2000;25A:297–304. 6. Tomaino MM. Treatment of Eaton stage I trapeziometacarpal disease. Ligament reconstruction or thumb metacarpal extension osteotomy? Hand Clin 2001;17:197–205. 7. Davis TR, Brady O, Barton NJ, Lunn PG, Burke FD. Trapeziectomy alone with tendon interposition or with ligament reconstruction? J Hand Surg 1997;22B:689–694. 8. Davis TR, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg 2004;29A:1069–1077. 9. Diao E. Trapezio-metacarpal arthritis. Trapezium excision and ligament reconstruction not including the LRTI arthroplasty. Hand Clin 2001;17:223–236. 10. Gerwin M, Griffith A, Weiland AJ, Hotchkiss RN, McCormack RR. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop 1997;342:42– 45. 11. Nylen S, Johnson A, Rosenquist AM. Trapeziectomy and ligament reconstruction for osteoarthrosis of the base of the thumb. A prospective study of 100 operations. J Hand Surg 1993;18B:616–619. 12. Rayan GM ,Young BT. Ligament reconstruction arthroplasty for trapeziometacarpal arthrosis. J Hand Surg 1997; 22A:1067–1076. 13. Burton RI, Pellegrini VD Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg 1986; 11A:324–332. 14. De Smet L, Sioen W, Spaepen D, van Ransbeeck H. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg 2004;9:5–9. 15. De Smet L, Vanfleteren L, Sioen W, Spaepen D, van Ransbeeck H. Ligament reconstruction/tendon interposition arthroplasty for thumb basal joint osteoarthritis: preliminary results of a prospective outcome study. Acta Orthop Belg 2002;68:20 –23. 16. Lins RE, Gelberman RH, Mckoewn L, Katz JN, Kadiyala RK. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg 1996;21A:202–209. 17. Liu Y, Chang MC. Ligament reconstruction and tendon interpositional arthroplasty for degenerative arthritis of the thumb trapeziometacarpal joint. Zhonghua Yi Xue Za Zhi (Taipei) 1999;62:795– 800. 18. Tomaino MM. Ligament reconstruction tendon interposition arthroplasty for basal joint arthritis. Rationale, current technique, and clinical outcome. Hand Clin 2001;17:207–221. 19. Tomaino MM, King J. Ligament reconstruction tendon interposition arthroplasty for basal joint arthritis: simplifying flexor carpi radialis tendon passage through the thumb metacarpal. Am J Orthop 2000;29:49 –50. 20. Tomaino MM, Pellegrini VD Jr, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg 1995;77A:346–355. 21. Barron OA, Eaton RG. Save the trapezium: double interposition arthroplasty for the treatment of stage IV disease of the basal joint. J Hand Surg 1998;23A:196–204. 22. Dell PC, Muniz RB. Interposition arthroplasty of the trapeziometacarpal joint for osteoarthritis. Clin Orthop 1987;220: 27–34. 23. Eaton RG, Glickel SZ, Littler JW. Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb. J Hand Surg 1985;10A:645–654. 24. Froimson AI. Tendon interposition arthroplasty of carpometacarpal joint of the thumb. Hand Clin 1987;3:489 –505. 25. Imaeda T, Cooney WP, Niebur GL, Linscheid RL, An KN. Kinematics of the trapeziometacarpal joint: a biomechanical analysis comparing tendon interposition arthroplasty and total joint arthroplasty. J Hand Surg 1996;21A:544–553. 26. Kleven T, Russwurm H, Finsen V. Tendon interposition arthroplasty for basal joint arthrosis. 38 thumbs followed for 4 years. Acta Orthop Scand 1996;67:575–577. 27. Menon J. Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis of the thumb. J Hand Surg 1995;20B:700 –706. 28. Menon J, Schoene HR, Hohl JC. Trapeziometacarpal arthritis— results of tendon interpositional arthroplasty. J Hand Surg 1981;6A:442–446.

 


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Maria Santos
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01:45 06 Nov 20
I am really satisfy with my hand surgery that was done by Dr. Alejandro Badia, and I want to thanks all the... professional personal and staff that always are very kind. I highly recommended!read more
Najlaa Bayram
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03:45 02 Nov 20
Dr. Badia is an outstanding Dr and surgeon. I first sought his expertise, in late 2013, after a misdiagnosis and a... botched surgery by another Dr that left me with unbearable pain and unable to move my right hand for months. After doing some research online, looking for some excellent hand surgeons, a lot of articles came up praising Dr. Badia's expertise and competence. I sent him an email explaining what happened, how the pain started and asked for his opinion. To my surprise, I received a thorough response the same day with detailed information. I right then decided to drive 4hours to go see him; I must say it was the best decision I made. From the 1st visit, Dr. Badia performed surgery to fix the initial issue and later did another surgery to correct the botched one; I couldn't be happier with the results. Earlier this year, I slipped and injured my left wrist. I made another trip to Miami and once again Dr. Badia came to the rescue. He did surgery on my left wrist after the conservative treatment didn't fully help and at the same time did a cubital nerve release on my right elbow that instantly stopped the pain I've been having. I HIGHLY recommend Dr. Badia; he's a true expert and an outstanding surgeon. His staff is very kind, professional, friendly and truly cares.read more
danadenni
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My husband and I contacted Dr Badia for my hand issues. I had researched approximately five hand specialists in... Florida and one in New York city before I found Dr Badia about an hour away from us. My husband and I went to Doral, Florida and the minute I met Dr Badia I knew he was going to do my surgery. He has personality plus !!! and loves what he does. He is kind, patient and listens to his patients. He respects your hands ! Dr Badia was highly recommended and I am so glad that we found him. He did the surgery on my hand and with a bit of rehab it healed better than I expected and my pain was gone ! Dr Badias office personnel are wonderful ! It is quite obvious that they love working there with him and that they love their jobs. My husband and I have never experienced an office with so many helpful and caring people. We both recommend Dr Badia. We still drive to his office for anything to do with hand issues and he takes care of whatever it is. We both trust our hands ONLY to him ! He is a gem.read more
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I first contacted Dr. Badia's clinic after I injured my hamate bone. I needed a surgery and someone in my family that... knew Dr. Badia convinced me that he was one of the best if not the best hand surgeon in the world. I am a high level Baseball player so I needed treatments in order to get back on the field as soon as possible. I have been able to book an appointment the next week which was great. I'm Canadian which made it tougher with my insurance company, but Dr. Badia's team has been really helpful with that, they sent numerous emails and even made some calls with the company to make sure I would not have any fees related to the consultation and surgery. The surgery went really well, without any complication and I don't think it would have been as quick and easy with anyone else than Dr. Badia and his team. I would definitively recomand Badia Hand to Shoulder Center to anyone in the need of treatments.read more
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I injured my shoulder right as we entered into a lockdown due to a pandemic. It was next to impossible to get anyone to... see me and assess my injury. Dr. Badia and his team, following carefully laid out safety protocols, were able to bring me in, have x-rays, MRI and thorough review of the findings all in ONE visit!!! I was given an interim treatment plan to bridge the gap as surgeries were restricted due to COVID-19. As soon as surgeries resumed, I was scheduled for my procedure. To say that both Dr. Badia and his team are amazing is an understatement. They helped me handle a difficult insurance approval process to ensure I had the best surgeon treating me and my procedure at The Surgery Center at Doral and communication with my PCP and Cardiologist was excellent. Everyone made me feel very safe and confident that I was in the best possible setting where I wouldn’t be exposed to needless risk in a traditional hospital. The results of my surgery so far have been amazing. I’ve had next to no pain post-op and my recovery is coming along at lightning speed thanks Dr. B’s amazing talent and the dream team he has at OrthoNow where I have been undergoing physical therapy. I couldn’t say enough good things about him and the team. His expertise and dedication to providing the best possible care using cutting edge technology make for patient centered care and well being vs. insurance driven red tape so often seen today. Highly recommend Dr. Badia!read more
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I went to Dr. Badia with a bad infection in my nail. He is so good at what he does and took care of me with such... concern. Gigi is the sweetest, cutest thing ever, who also made sure that I was comfortable and helped so I would not be nervous. The whole staff makes you feel like family. Thank you everyone from the bottom of my heart and I would recommend Dr. Badia's expertise and his office to anyone. So, if you have an injury or a problem, please go see him.read more
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Tele-med conference with Dr. Badia and staff regarding "golfer's elbow"
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Staff was very welcoming and accommodating.. Dr. B. was very professional and caring.He seems to be a driving... innovator and in improving the lives of patients in the South Florida area.read more
julio hernandez
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Dr Badia is the best orthopedic surgeon in Miami hands down. I need surgery because of a multiple fracture in my left... forearm. Went to other doctors (UM, mount Sinai) and they didn’t promise me I would recover 100% of my injuries and told me I would not be able to do sports again. Dr Badia did tell me I would heal 100% and it’s true. I did a much simpler surgery and fixed me in no time. Would recommend to anyone. Two thumbs upread more
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Wonderful practice very welcoming staff and amazing service with top notch technology. I was a patient and I am a... colleague of Dr Badia and had the best treatment for my hand injury got diagnosed in the spot with a 3D Ultrason super modern technology and treated at the same moment. Really superb experience being a physician I absolutely recommended Dr Badia Hand and Shoulder Center at OrthoNOW!read more
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Excellent visit. I injured my finger yesterday and was seen today by Dr. Badia. The staff was friendly and very... efficient and the doctor spent more than enough time explaining what was going on and explaining my options. Truly a great experience.read more
Luisa Alfonso
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The Dr and staff are professional and friendly. I’m happy I came here and I received the attention and answers I... needed. I had injured my hand and I left the office feeling better. Thank you all for everything!!!read more
Robledo Aybar
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Due to a fall, I fractured my wrist in late Nov. 2018. Dr Badia and his team helped me overcome this issue and today... I’m working, and back on my bike and running. The best service and experience!read more
Ellen Westbrook
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23:08 29 Jul 19
Staff displayed professionalism and caring. Dr. Badia was as enthusiastic as I was about this surgery to improve the... function of my hand. The surgical day process was smooth; I was kept informed every step of the way. I felt comfortable and safe.read more
victor mendelsohn
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02:37 30 May 19
From the first call I made to Dr. Badia‘s office I was impressed by the professionalism of the person who answered... the phone. When I arrived at the office for my appointment I was once again greeted in a professional manner. This professionalism radiated through all of the team. I hadn’t seen Dr. Badia for over 10 years and he greeted me as if we’ve been in contact with each other for years.read more
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18:19 24 Apr 19
From my first visit the staff as well as the Dr. Badia have been exceptionally professional and caring. I had an injury... to my pinky finger, the required a placement of a rod in order to align. The surgery went well and was scheduled right away. The office staff has been amazing with scheduling and confirming appointments. Overall I am very happy with the care i received as well as the results. My finger healed and my range of motion has also gotten much better. Thank you Dr. Badiaread more
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