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American Association of Plastic Surgeons

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Regeneration Of An Articular Surface In Degenerative Thumb Carpo-metacarpal Joint Disease By Distraction And Autologous Fat Transfer
Raul Cortes, MD, Daniel Calva, MD, Roger K. Khouri, MD.
Miami Hand Center, Key Biscayne, FL, USA.

PURPOSE: Osteoarthritis of the thumb carpo-metacarpal joint (CMCJ) is a common ailment. The standard trapezoidectomy and tendon interposition arthroplasty is invasive and irreversible. Fat is a readily available autologous spacer that can be harvested with essentially no morbidity and simply injected into a temporally restored joint space by external distraction. We hereby present our experience with autologous fat interposition arthroplasty into externally distracted CMCJ.
METHODS: 80Consecutive patients with GradeIII-IVCMCJ arthritis reluctant to have a trapezoidectomy agreed to undergo this less invasive arthroplasty. Under fluoroscopic control we apply an external distraction frame across the thumb CMCJ. Acute intraoperative distraction restores the joint space and makes room for the injection of 3-5ml of a paste of Tefla rolled lipoaspirate. We remove the distractor at 4Weeks and splint for another week before allowing the patient to return to normal activities.
RESULTS: At 12months follow up, their pain scale decreased from 8.2 to 2.6 and their pinch strength increased from 4.4 to 9.4 (P<0.01). Radiographically, the joint space widened by 1.1 mm and MRI studies of 10patients reveal cartilage like material in the joint space. Three early failures were converted to trapeziodectomy. All others had rapid recovery and were highly satisfied with the procedure.
CONCLUSION: Our experience shows that distraction and autologous fat transfer might offer a less invasive regenerative alternative to this very common degenerative condition.


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