1. Thumb CMC Arthritis Implant or Suspension ? Matthew D Putnam, MD Orthopaedic Staff ACMC CMD 945 th FST, 452 CSH USAR Orthopaedics Professor @ University of Minnesota Copyright MD Putnam, MD

2. COI(s) Unrelated: Stockholder: Apple, BK Health, Cephiad, Google, HP, IBM, J & J, Microsoft, 3M, Medtronic, Stericycle Board Member: BK Health Employer(Reserve): US Army Related: None (that I Know) Copyright MD Putnam, MD

3. Thumb CMC Arthritis RX Pain is indication Surgery will not improve strength (fusion?) No proven benefit to replacements Silicone is still used successfully in one series Does “anything” on cartilage make sence Resection is the comparative standard Cochrane Database Be Aware ADDuction deformity and MCPJ hyperextension instability. Copyright MD Putnam, MD Why are we here?

4. Really? The best we can do? Copyright MD Putnam, MD

5. SRA Copyright MD Putnam, MD Primary Issue – How to get the Delta thing In???

6. About this Time Copyright MD Putnam, MD

8. That Guy – Designed by Surgeon(s)(?COI) Copyright MD Putnam, MD

10. The results of 479 thumb carpometacarpal joint replacements reported in the Norwegian Arthroplasty Register In this study we report the results of thumb carpometacarpal (CMC) joint replacements in the Norwegian population over a 17-year period. In total, 479 primary replacements performed from 1994 to 2011 were identified in the Norwegian Arthroplasty Register. Implant survival and risk of revision were analyzed using Cox regression analyses. Four different implant designs were compared and time trends were analyzed. The overall 5 and 10 year survivals were 91% and 90%, respectively. The newer metal total arthroplasties did not outperform the older silicone and mono-block implants. At 5 years, the implant survival ranged from 90% to 94% for the different implant brands. Gender, age, and diagnosis did not influence the risk of revision. The incidence of thumb CMC joint replacement did not change during the study period. Despite relatively satisfactory implant survivorship in our register study, current evidence does not support widespread implementation of thumb CMC replacements. Yngvar Krukhaug S A Lie L I Havelin Ove Furnes L M Hove G Hallan The Journal of hand surgery, European volume 04/2014≥ Copyright MD Putnam, MD

11. Chan, Neu, Komvopoulos, Reddi, DiCesare (UCSD AND Berkeley)

12. MINIMUM DIFFERENCE Copyright MD Putnam, MD

13. Putnam et al Copyright MD Putnam, MD

16. Necessity Article Demographics/Method Copyright MD Putnam, MD

17. TESS RESULTS Copyright MD Putnam, MD Demographics: M/F = Age (avg) = F/U (avg) =

18. SURGICAL METHOD STEP BY STEP POST OP IN FIRST 2 WEEKS – 2 TO 6 – 6 TO 12 – + 12 DURABILITY Copyright MD Putnam, MD

19. CASE 1 Copyright MD Putnam, MD

20. WARNING LABEL Basilar Thumb Arthritis (1 st CMC Arthritis) Most common arthritic joint in the hand 1 in 4 women 1 in 12 men Pain – Progressive Dysfunction Writing Holding heavier books Turning keys, doorknobs, opening jars

21. BENGTON SCORE MCPJ HYPEREXTENDED 1ST WEB SPACE MID-CARPAL LAXITY Copyright MD Putnam, MD

22. THE FUTURE COLLAGEN/CARTILAGE IMPLANTS………… BETTER ID OF NON-CANDIDATES – GENETICS – LAXITY – PRE-OPERATIVE ID OF GOALS (DASH, DEPRESSION, OTHER) – REHAB (DOES STRENGTHENING THE 1 ST DI REALLY WORK) Copyright MD Putnam, MD

23. CASE 2 4 FLAP AND HYPEREXTEND Copyright MD Putnam, MD

24. 3.98 4.61 4.34 4.04 3.89 4.57 (Ranges exclude one patient with poor outcome: Scored lowest In all categories)

25. 1. Prosper Benhaim - brief introduction, anatomy, resection arthroplasty 2. James Fletcher - trapezial resection and ligament reconstruction 3. Matthew Putnam - intermetacarpal suspension, implants 4. Catherine Curtin - tightrope technique 5. Philip Blazar - salvage for the failed trapeziectomy patient Copyright MD Putnam, MD