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Thumb Carpometacarpal Joint Resurfacing With Autologous Ear Cartilage

Nickell, William B. MD, FACS*†‡

doi: 10.1097/SAP.0b013e3182650ce4
Hand Surgery

Purpose: A study was designed to ascertain the long-term effectiveness of using autologous full-thickness ear cartilage to resurface the arthritic face of the trapezium, leaving the body of the trapezium intact. The value of injection of the involved carpometacarpal (CMC) joint with local anesthetic in predicting improvement from the surgery was also studied.

Methods: An operation was used to enter the CMC joint of the thumb between the thenar muscles and the abductor tendon. The articular surface of the trapezium was resected and resurfaced with full-thickness ear cartilage from the patient’s ear. Patients were selected based on constant, unremitting pain. All patients also had x-ray evidence of severe arthritis at the CMC joint of the thumb. Both thumbs were evaluated for pain, range of motion, key and palmar pinch, and grip strength before the surgery and followed up for a minimum of 30 months to be included in the study.

Results: Fifty-nine patients had ear cartilage arthroplasty from 1997 to 2007 by the same surgeon with a total of 67 operations (8 patients, all women, had both thumbs operated). Forty-nine of these patients, 4 men and 45 women (53 hands), were available for follow-up and constitute the study group. Eight procedures were done on the left hand, and 45, on the right. There were no ear complications and no cartilage extrusions. All patients had improved range of motion and greatly decreased pain. Strength was equaled or exceeded the unoperated thumb. Preoperative joint injection was a good predictor of postoperative pain relief. All patients were pleased with the result and said that they would have the surgery again.

Conclusions: Thumb CMC joint arthroplasty with autologous ear cartilage and preservation of the body of the trapezium is an effective alternative to existing procedures.

There is no morbidity to the ear, and predictable long-term improvement in thumb pain and strength can be obtained. Injection of the CMC joint before surgery with local anesthetic is a reliable predictor of improvement from surgery.

From the *Department of Surgery, Division of Plastic Surgery, St. Vincent’s Hospital; †Trinity Medical Center; and ‡Outpatient Services East, Birmingham, AL.

Received May 20, 2012, and accepted for publication, after revision, June 15, 2012.

Detailed informed consent was obtained from all patients, and the institutional review board gave approval for the study.

Conflicts of interest and sources of funding: none declared.

Reprints: William B. Nickell, MD, FACS, Department of Surgery, Division of Plastic Surgery, St. Vincent’s Hospital, Trinity Medical Center, and Outpatient Services East, 3745 Dunbarton Dr, Birmingham, AL, 35223. E-mail: wnickell@gmail.com.

© 2014 by Lippincott Williams & Wilkins