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Fat grafting for basal joint arthritis
Stephen M. Lu, M.D., M.Div1, Armen Kasabian, MD1, Alfred T. Culliford, IV, MD2.
1Northwell Health, Hofstra Northwell School of Medicine, Lake Success, NY, USA, 2Northwell Health, Hofstra Northwell School of Medicine, Staten Island, NY, USA.

BACKGROUND: Patients with basal joint arthritis can suffer from the symptoms of progressive joint space narrowing; joint degeneration with resultant pain and ligamentous laxity lead to subluxation and disabling weakness. Treatment options include diverse nonsurgical and surgical options. Splinting, hand occupational therapy, NSAIDs, and steroid injections can be effective in treating early stage disease. For patients with continued pain and involvement of joint cartilage, surgical intervention ranges from wedge osteotomy or volar ligament reconstruction for minimally affected cartilage, to trapeziectomy with or without ligament reconstruction or tendon interposition for more advanced disease, to joint arthroplasty or arthrodesis for refractory disease or failed reconstructions. While these surgical techniques often alleviate pain, more invasive techniques are accompanied by substantial functional reduction in grip strength, range of motion, and joint stability; in addition there is significant time required for rehabilitation before return to work or full hand use. Autologous fat grafting to the carpometacarpal joint has been discussed in limited case reports with promising results. The authors here present the largest series to date of patients treated with fat graft injections to the carpometacarpal (basal) joint. The technique is a minimally invasive one which preserves the joint space without further compromising functional outcomes. Additionally, fat grafting maintains the future option for all other known surgical treatments and does not affect the possible effectiveness of more traditional surgical treatments. METHODS: This was a retrospective study involving the patients of two surgeons. All patients treated with autologous fat grafting to the basal joint between 2010 and 2016 were included in this study. Ten patients (11 joints) were included, 6 women and 4 men, ranging in age from 44 to 64. All patients initially underwent conservative measures, including rest, splinting, and NSAIDs. Patients received an average of 3.7 steroid injections prior to surgery. One had undergone previous trapeziectomies but had persistent pain. Patients were then offered autologous fat grafting as a surgical option with the possibility of more invasive procedures in the future. Mean follow-up was 32 months with a range of 1 month to 6 years. RESULTS: All patients experienced subjective improvement in pain and no additional loss of function. There were no complications for any of the procedures. Two patients required further surgical intervention. One fell down a flight of stairs 1 week post op and underwent repeat fat grafting 8 months later; another underwent osteophyte removal to facilitate usage of a walker. One patient required a steroid injection six years after the operation. Patient satisfaction was subjectively excellent. CONCLUSIONS:
Basal joint arthritis remains a difficult condition to treat, balancing pain and functional needs against the degree of surgical invasiveness. Autologous fat grafting to the basal joint shows promise as a minimally invasive treatment for early stage disease with excellent relief of pain, no functional loss, and relatively quick return to work and daily activities.


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