Preservation Arthroplasty for Basal Joint Arthritis Using Arthroscopy and Autologous Fat Grafting With Platelet-rich Plasma

Abstract

Background: Prior studies have shown that intra-articular injection of autologous fat may be a viable, less invasive approach for the treatment of carpometacarpal (CMC) joint arthritis, compared with trapeziecetomy. Small joint arthroscopy has also been found to be a useful tool in evaluation and treatment of arthritis. The authors present a treatment for CMC arthritis combining a minimally invasive approach for arthroscopic debridement with autologous fat grafting and platelet-rich plasma (PRP) injection. Methods: Patients with Eaton stage II–IV CMC osteoarthritis underwent arthroscopic debridement and injection of autologous fat and PRP into the joint. Pre- and postoperative pain scores, functional outcomes, radiographic improvement in joint subluxation, patient satisfaction, and complications were evaluated. Results: Forty-eight thumb CMC joint arthroscopies with fat grafting and PRP were performed. No intraoperative or immediate postoperative complications were experienced. No patients required revision surgery. Average preoperative pain scores with activity improved from 8.9 ± 0.9 to 3.3 ± 2.2 (P < 0.0001) and at rest improved from 5.0 ± 2.5 to 1.0 ± 1.3 (P < 0.0001). M1M2 overlap was used to measure radiographic subsidence. This improved from 4.4 ± 2.8mm preoperatively to 6.8 ± 2.3mm postoperatively, reflecting a relative improvement of 70% (P < 0.0042). High patient satisfaction was noted. Conclusions: Treatment of the CMC joint using arthroscopic technique combined with autologous fat and PRP is effective in treating pain and joint subluxation. Additional prospective studies are underway for comparison to traditional arthroplasty techniques and to evaluate this technique’s potential for other small joint pathology.