Donald Dewar Consultant Plastic Surgeon Leeds General Infirmary OA and the hand Donald Dewar Consultant Plastic Surgeon Leeds General Infirmary

Osteoarthritis degenerative condition characterised by loss of articular cartilage, resulting in pain, swelling, loss of movement, and deformity

Aetiology mostly age-related and degenerative (“wear and tear”) relationship to heavy work obscure post-traumatic (degeneration of damaged joint) genetic strong family history early onset and rapid progression many joints involved specific patterns of involvement in the hand

Pathophysiology exact mechanism unknown progressive loss of articular cartilage stage I softening stage II fibrillation stage III fragmentation stage IV eburnation

Sites affected in the hand wrist primary secondary (e.g. SLAC and SNAC) thumb CMCJ DIPJs other joints

Symptoms pain (at rest and on movement) swelling restriction of ROM secondary deformity osteophytes joint deviation/subluxation

Symptoms loss of function pain (at rest and on movement)  swelling  restriction of ROM  secondary deformity  osteophytes joint deviation/subluxation loss of function

Signs swelling restriction of ROM secondary deformity bony (Heberden’s and Bouchard’s nodes) soft tissue (less than in RA) restriction of ROM crepitus secondary deformity osteophytes joint deviation/subluxation (e.g. square thumb, Z-thumb deformity)

X-rays loss of joint space sub-chondral sclerosis bone cysts osteophytes secondary deformity

Assessment assess both deformity and function treatment aims to reduce pain improve function with minimal complications

Treatment Analgesia (especially NSAIDs) Activity modification Appliances (splints) Articular steroid injection

Treatment soft tissue Alignment Arthroplasty Arthrodesis Amputation

Treatment – thumb CMCJ change job/retire splint steroid injection surgery trapeziectomy +/- LRTI capsular tightening beak ligament reconstruction arthroplasty

Treatment - PIPJs arthroplasty arthrodesis Swanson’s most reliable pyrocarbon (squeaky) others not suitable for the “high-demand” hand arthrodesis let patient choose angle best option for younger patients (reliable) annoyingly inconvenient

Treatment - DIPJs fusion a good option for pain/deformity many techniques arthroplasty occasionally used let patient choose angle (but usually straight)