Pyrocardan arthroplasty of secondary osteoarthritis of the scaphotrapeziotrapezoid joint

Abstract

Introduction: Primary osteoarthritis can be considered to be the ‘wear and tear’ of cartilage as associated with age related changes. Secondary Osteoarthritis usually involves a specific ‘trigger’ which initiates these cartilaginous changes. Often overworking and overloading of the joints, particularly in the wrist can allude to this diagnosis. This case report documents a retired dentist having acquired secondary osteoarthritis of the Scaphotrapeziotrapezoid joint (STT) in the left wrist as an occupational hazard. Treatment for this presentation was the use of the Pyrocardan prosthesis. Methods: A retired dentist presented with Secondary Osteoarthritis of the left STT joint due to pre-existing fusions of the trapezio-metacarpal joint and metacarphophalangel joint of the ipsilateral thumb underwent the Pyrocardan STT joint arthroplasty. The QuickDASH ( Disabilities of Arm, Shoulder and Hand ), PRWE ( Patient Rated Wrist Evaluation ), Mayo Performance Wrist scores were used preoperatively and postoperatively to assess functional outcome. Results: The PRWE and Mayo Performance Wrist scores had significantly improved following surgery. The QuickDASH score remained the same because of his concomitant shoulder disorder. The range of wrist movement was satisfactorily maintained at the end of one year follow-up. The hand and pinch grip strength had also improved. Conclusions: Pyrocardan STT joint arthroplasty is a good treatment option because it not only provides a good pain relief but also maintains satisfactory functional wrist movements. Practicing dentists should look to adopting the appropriate finger rest techniques and fulcrum rests when handling dental equipment to reduce the muscle stress and undue load on the STT and other joints in the wrist and hence reduce the risk of OA.