RESEARCH ARTICLE


Clinical Results of 40 Consecutive Basal Thumb Prostheses and No CRPS Type I After Vitamin C Prophylaxis



Paul E. Zollinger*, 1, Halil Ünal1, Maarten L. Ellis1, Wim E. Tuinebreijer2
1 Department of Orthopaedic Surgery, Ziekenhuis Rivierenland, Pres. Kennedylaan 1, 4002 WP Tiel, The Netherlands
2 Relweg 59, 1949 EC Wijk aan Zee, The Netherlands


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Creative Commons License
© Zollinger et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Orthopaedics, Ziekenhuis Rivierenland Tiel, P.O. Box 6024, 4000 HA Tiel, The Netherlands; Tel: +31344674217; Fax: +31344632903; E-mail: PE.Zollinger@tiscali.nl


Abstract

Complex regional pain syndrome (CRPS) type I may occur as complication after any type of surgery for basal joint arthritis of the thumb. We investigated prospectively in an ongoing study our results after a fully standardized treatment with a total joint prosthesis under vitamin C prophylaxis.

Patients with trapeziometacarpal arthritis stage II or III according to Dell, and no benefit from conservative treatment, were selected to undergo joint replacement with a semi-constrained hydroxyapatite coated prosthesis.

First web opening and visual analogue scale (VAS) scores for pain, activities of daily living (ADL) and satisfaction were taken pre and postoperatively. Vitamin C 500 mg daily was started two days prior to surgery during 50 days as prevention for CRPS. Post-operative treatment was functional.

We performed 40 implantations for trapeziometacarpal arthritis in 34 patients (mean age 60.8 years; 27 females, 7 males) with a mean follow-up of 44 months. Operations were performed in day care under regional (or general) anesthesia.

First web opening increased with 15.4 degrees and there was a significant improvement for pain, ADL and satisfaction as well (p = 0.000). Patient satisfaction was strongly associated with the amount of pain reduction. According to the Veldman and IASP criteria, there were no cases of CRPS.

The overall complication rate for this procedure is high. Literature reports 5 cases of CRPS after 38 operations with the same implant (13%). We advise vitamin C as prophylaxis against CRPS in trapeziometacarpal joint replacement.

Keywords: Trapeziometacarpal arthritis, joint replacement, reflex sympathetic dystrophy, ascorbic acid, CMC I prosthesis, complex regional pain syndrome..