Eigenfettinjektion in das Sattelgelenk zur Behandlung der Rhizarthrose – eine viel versprechende Therapieoption

Zusammenfassung

Klassische chirurgische Operationstechniken zur Behandlung der Rhizarthrose führen zu einer unwiderruflichen Veränderung der Anatomie der Handwurzel. Auch die Arbeitsunfähigkeit und das Wiedererlangen der Handfunktion nach diesen Eingriffen dauert in der Regel 12–16 Wochen. Daher erscheint eine nicht ablative und gering invasive chirurgische Therapieoption der Sattelgelenksarthrose eine wünschenswerte Alternative. In einer Pilotstudie injizieren wir Fettgewebe in das arthrotisch veränderte Daumensattelgelenk. Die ersten Ergebnisse sind viel versprechend. Der durchschnittliche präoperative Schmerz nach VAS betrug 7,4 bei Belastung und 3,8 in Ruhe. Der durchschnittliche postoperative Schmerz nach einem Monat betrug 2,2 bei Belastung und 0 in Ruhe, sowie 2,4 und 0,8 nach 3 Monaten. Die Schmerzminderung einen Monat nach Injektion bei Belastung war statistisch signifikant (p=0,042). Die Kraft des Grobgriffes betrug 78% und des Pinch Griffes 74% im Vergleich zu der gesunden Seite präoperativ. Die Kraft des Grobgriffes betrug 89% und die des Pinch Griffes 80% im Vergleich zu der gesunden Seite einen Monat postoperativ und 93% bzw. 89% 3 Monate postoperativ. Entsprechend reduzierte sich der DASH Score von präoperativ durchschnittlich 58 auf 36 nach einem bzw. 33 nach 3 Monaten. Die Verbesserungen der Handfunktion waren statistisch signifikant (p=0,042 und p=0,043). Es traten keine Komplikationen auf und alle Patienten waren zufrieden. Diese vorläufigen Ergebnisse sind viel versprechend, da die Eigenfettinjektion auch im Falle eines möglichen Therapieversagens, anders als die meisten bekannten Opera­tionstechniken, den Wechsel auf eine andere klassische Opera­tionsalternative nicht ausschließt.

Abstract

Classical surgical options for osteoarthritis of the thumb carpometacarpal joint irreversibly des­troy the normal anatomy of the wrist. Although overall satisfaction rates with these procedures are high, time to achieve normal hand function and ability to work may take 12–16 weeks. Therefore a non-ablative less invasive surgical option would be interesting. We injected adipose tissue into the thumb carpometacarpal joint in a pilot study. Average preoperative pain according to a VAS was 7.4 in action and 3.8 during rest. It was reduced considerably to 2.2 in action and 0 during rest after 1 month and to 2.4 and 0.8, respectively, 3 months after surgery. The reduction of pain in action was statistically significant 1 month after injection (p=0.042). Average grip strength was 78% and pinch grip strength was 74% in comparison to the healthy side preop­eratively, 89% and 80% one month postoperatively and 93% and 89%, respectively, 3 months postoperatively. An average DASH score of 58 preoperative was reduced to 36 after 1 month and 33 after 3 months. The amelioration of hand function was statistically significant (p=0.042 and p=0.043). There were no side effects and all patients were satisfied. These preliminary results are promising. Adipose tissue injection seems to be an alternative to consider, especially as it does not exclude classical surgical options in cases of failure.

Schlüsselwörter

Arthrose - Resektions-Arthroplastik - Daumensattelgelenk - Daumen - Fettgewebe

Key words

osteoarthritis - resection arthroplasty - thumb carpometacarpal joint - thumb - adipose tissue

• Literatur

• 1 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg Br 1994; 19: 340-341
• 2 Cook GS, Lalonde DH. MOC-PSSM CME article: Management of thumb carpometacarpal joint arthritis. Plast Reconstr Surg 2008; 121: 1-9
• 3 Ellis CV, Kulber DA. Acellular dermal matrices in hand reconstruction. Plast Reconstr Surg 2012; 130: 256S-269S
• 4 Hohendorff B, Staub L, Kaiser T et al. Working ability after tendon interposition arthroplasty for degenerative arthritis of the thumb trapeziometacarpal joint. Handchir Mikrochir Plast Chir 2008; 40: 175-181
• 5 Ingegnoli F, Soldi A, Meroni PL. Power Doppler sonography and clinical monitoring for hyaluronic Acid treatment of rhizarthrosis: a pilot study. J Hand Microsurg 2011; 3: 51-54
• 6 Huang JI, Zuk PA, Jones NF et al. Chondrogenic potential of multipotential cells from human adipose tissue. Plast Reconstr Surg 2004; 113: 585-594
• 7 Zuk PA, Zhu M, Ashjian P et al. Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell 2002; 13: 4279-4295
• 8 ter Huurne M, Schelbergen R, Blattes R et al. Antiinflammatory and chondroprotective effects of intraarticular injection of adipose-derived stem cells in experimental osteoarthritis. Arthritis Rheum 2012; 64: 3604-3613
• 9 Wu L, Cai X, Zhang S et al. Regeneration of articular cartilage by adipose tissue derived mesenchymal stem cells: perspectives from stem cell biology and molecular medicine. J Cell Physiol 2013; 228: 938-944
• 10 Toupet K, Maumus M, Peyrafitte JA et al. Long-term detection of human adipose-derived mesenchymal stem cells after intraarticular injection in SCID mice. Arthritis Rheum 2013; 65: 1786-1794
• 11 Karagianni M, Kraneburg U, Kluter H et al. Autologous fat grafts and supportive enrichment with adipose tissue stromal cells. Handchir Mikrochir Plast Chir 2013; 45: 93-98
• 12 Brayfield C, Marra K, Rubin JP. Adipose stem cells for soft tissue regeneration. Handchir Mikrochir Plast Chir 2010; 42: 124-128
• 13 Rennekampff HO, Reimers K, Gabka CJ et al. Current perspective and limitations of autologous fat transplantation—“consensus meeting” of the German Society of Plastic, Reconstructive and Aesthetic Surgeons at Hannover; September 2009. Handchir Mikrochir Plast Chir 2010; 42: 137-142
• 14 Herold C, Pflaum M, Utz P et al. Viability of autologous fat grafts harvested with the Coleman technique and the tissu trans system (shippert method): a comparative study. Handchir Mikrochir Plast Chir 2011; 43: 361-367
• 15 Fisher C, Grahovac TL, Schafer ME et al. Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation. Plast Reconstr Surg 2013; 132: 351-361
• 16 Allen Jr RJ, Canizares Jr O, Scharf C et al. Grading lipoaspirate: is there an optimal density for fat grafting?. Plast Reconstr Surg 2013; 131: 38-45
• 17 Schutz A, Dobner P. Effect of wrist arthroscopy with intraarticular hyaluronan substitution therapy: a randomised, controlled, prospective, non-blinded, single-centre, comparative trial. Handchir Mikrochir Plast Chir 2013; 45: 277-284
• 18 Hempfling H. Intra-articular hyaluronic acid after knee arthroscopy: a two-year study. Knee Surg Sports Traumatol Arthrosc 2007; 15: 537-546
• 19 Heyworth BE, Lee JH, Kim PD et al. Hylan versus corticosteroid versus placebo for treatment of basal joint arthritis: a prospective, randomized, double-blinded clinical trial. J Hand Surg Am 2008; 33: 40-48
• 20 Schibli-Beer S, Mark G, Canova M. Results after simple trapeziectomy and capsular fixation for osteoarthritis of the trapeziometacarpal joint. Handchir Mikrochir Plast Chir 2008; 40: 169-174
• 21 Wittemann M, Demir E, Sauerbier M et al. The Epping resection-suspension arthroplasty procedure. A standard procedure in the operative treatment of trapeziometacarpal osteoarthrosis?. Handchir Mikrochir Plast Chir 2002; 34: 49-58
• 22 Rab M, Gohritz A, Gohla T et al. Long-term results after resection arthroplasty in patients with arthrosis of the thumb carpometacarpal joint: comparison of abductor pollicis longus and flexor carpi radialis tendon suspension. Handchir Mikrochir Plast Chir 2006; 38: 98-103