First of all, we wish to express our warmest thanks to our correspondents Herold et al. and Pinkawa. Autologous fat transplantation can certainly constitute an interesting alternative, although its efficacy will need to be proved by means of medium-term to long-term study results. The cited references present results that are, on the one hand, based on a follow-up period of only three months (in the correspondence: Haas et al.), and, on the other hand, an average of 12 months‘ follow-up, with individual observations at 24 months (in the correspondence: Herold et al. and Erne et al.). Resection arthroplasty with or without suspension for the treatment of CMC-1-Arthritis Eaton/Littler stages 2–4 has in the meantime become a sufficiently studied therapeutic approach in terms of evidence-based aspects, with good results in the long term (1, 2). Revision surgeries after trapeziectomy because of recurrent or persistent pain are therefore rare. Alternative methods will have to measure up to these well-proven surgical techniques.
Radiotherapy to treat arthritis of the small joints of the hand certainly constitutes a tempting non-surgical approach. But for this approach too, randomized, controlled trials with long-term follow-up periods are lacking. The precise application of ionizing radiation to the target organ cannot always be reliably delivered to the hand, with its many joints in close proximity. For the treatment of rhizarthrosis, Kaltenborn et al. defined the clinically identifiable painful region with an additionally arbitrarily selected safety margin of 1 cm, respectively, in each direction (3). If this radiation field is put in relation to the actually measured CMC-1 joint areas of an average of 16.03 mm at the mean sagittal diameter for the metacarpal joint surface area and of 11.96 mm for the surface area of the trapezium joint, a not insignificant and unnecessary risk of damage to the adjacent anatomical structures exists (4). Viewing the literature, radiotherapy for the treatment of rhizarthrosis has been studied overwhelmingly. Scarce data exist regarding radiotherapy of the digital joints. From a surgical perspective, the substantial risk of tissue scarring owing to radiotherapy needs to be borne in mind, which might render a subsequent surgical procedure difficult.
On behalf of the authors
PD Dr. med. Christian Karl Spies
Abteilung für Handchirurgie,
Vulpius Klinik, Bad Rappenau
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Gangopadhyay S, McKenna H, Burke FD, Davis TRCC: Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am 2012; 37: 411–7 CrossRef MEDLINE|
|2.||Spekreijse KR, Vermeulen GM, Kedilioglu MA, et al.: The effect of a bone tunnel during ligament reconstruction for trapeziometacarpal osteoarthritis: a 5-year follow-up. J Hand Surg Am 2015; 40: 2214–22 CrossRef MEDLINE|
|3.||Kaltenborn A, Bulling E, Nitsche M, Carl UM, Hermann RM: The field size matters: low dose external beam radiotherapy for thumb carpometacarpal osteoarthritis. Strahlenther Onkol 2016; 192: 582–8 CrossRef MEDLINE|
|4.||Leversedge FJ: Anatomy and Pathomechanics of the thumb. Hand Clin 2008; 24: 219–29 CrossRef MEDLINE|
|5.||Spies CK, Langer M, Hahn P, Müller LP, Unglaub F: The treatment of primary arthritis of the finger and thumb joint. Dtsch Arztebl Int 2018; 115: 269–75 VOLLTEXT|