Thumbs up for im­plant that treats arthri­tis in hands

Scottish Daily Mail - - Good Health - A NEW im­plant for arthritic thumb joints is avail­able on the NHS. Re­tired art teacher Bob Stafford, 70, from Wil­barston, Northamp­ton­shire, was one of the first to ben­e­fit, as he tells ADRIAN MONTI.  carTiva costs about £3,000 to the nhs and £6,000 pri­vat

THE PA­TIENT

Af­ter 35 years as a school teacher, I de­cided to ful­fil my long-held am­bi­tion of set­ting up my own pot­tery and ceram­ics stu­dio. But soon af­ter start­ing my new ven­ture seven years ago, I be­gan suf­fer­ing shoot­ing pains in my thumbs. I took painkiller­s and used ibupro­fen gels, but noth­ing re­ally worked.

As the pain in my left thumb wors­ened and the move­ment be­came more re­stricted, I de­cided to see my GP. ev­ery­day tasks such as un­screw­ing lids and ty­ing my shoelaces be­came a strug­gle, and I re­alised my thumbs had ef­fec­tively worn out.

At the start of 2013, I was re­ferred to the arthri­tis clinic at my lo­cal hos­pi­tal, where X-rays re­vealed os­teoarthri­tis in the base of both thumbs. I joked it must have been caused by press­ing all those draw­ing pins into school no­tice­boards over the years.

By now I was strug­gling to work in my stu­dio. Han­dling heavy, cold clay made my thumbs even more painful.

Af­ter my di­ag­no­sis, I had cor­ti­sone in­jec­tions into the joints to ease the pain by re­duc­ing the swelling. But six months later the ef­fects had worn off.

My GP said there were two sur­gi­cal op­tions. the first in­volved re­mov­ing a bone in the joint, which would stop the pain of bone rub­bing against bone and re­store move­ment, although my thumbs would be left with little strength.

the sec­ond was fus­ing the thumb joint us­ing metal and screws so it was rigid. this would make it stronger and pain-free, but would not al­low any move­ment — which would mean no more pot­tery.

So, I set about do­ing my own re­search and soon found Chris Bain­bridge, a hand sur­geon at the royal Derby Hos­pi­tal. My GP re­ferred me for an NHS ap­point­ment there in De­cem­ber 2015.

Mr Bain­bridge told me about a new oper­a­tion be­ing tri­alled where they put a syn­thetic car­ti­lage im­plant into the joint where the nat­u­ral car­ti­lage had worn away.

It would re­store my thumb to its orig­i­nal pow­ers, mean­ing I could re­turn to the pot­tery wheel.

As no bone would be re­moved or fused, the sur­geon said I could have one of the more tra­di­tional op­er­a­tions if the trial failed.

I was de­lighted to go for surgery on my left thumb in March 2016. I was awake but se­dated dur­ing the oper­a­tion, which took less than an hour. I went home the same day with my arm ban­daged up, but it didn’t hurt much.

Af­ter ten days, the ban­dages were taken off and my lower arm was put into a plas­ter cast for eight weeks — the doc­tors wanted to en­sure the joint was fully healed be­fore any move­ment was tried.

once the cast was re­moved, I be­gan phys­io­ther­apy: at first once a week, and then ev­ery month, for a year.

the arthritic pain had gone straight away, but it took more than a year of build­ing up strength and flex­i­bil­ity for it to feel ‘­nor­mal’. By then, I could even help my son with his join­ery busi­ness.

I had my right thumb done in March last year, but this time, fol­low­ing the suc­cess of the trial, I didn’t have to have my hand in a cast. I was the first per­son to have both thumbs treated this way.

I cel­e­brated by throw­ing a pot for Mr Bain­bridge as a thank you.

THE SUR­GEON

CHRIS BAIN­BRIDGE is a con­sul­tant hand sur­geon at royal derby hos­pi­tal. oS­teoArtHrI­tIS in the thumb is ex­tremely com­mon as we age. It hap­pens when the car­ti­lage cov­er­ing the ends of the bones where the thumb meets the palm gets worn away. Bone then rubs against bone, caus­ing in­flam­ma­tion and pain.

Ge­net­ics is the cause, rather than overuse. But if you de­velop arthri­tis, us­ing the joint will make the pain more se­vere — and it’s hard not to use our thumbs. As the dis­com­fort wors­ens, strength and dex­ter­ity suf­fer, mak­ing ev­ery­day ac­tiv­i­ties re­mark­ably tough.

the first line of treat­ment is painkillin­g gels or learn­ing ex­er­cises to strengthen the small mus­cles at the base of the thumb. A splint around the wrist might be sug­gested to keep the thumb in place, but it’s a tem­po­rary fix as the joint will worsen over time re­gard­less.

An­other op­tion is a steroid jab. But be­cause the joint is so small, not much can be in­jected, so the re­lief is very short-lived.

the fi­nal op­tion is surgery. for more than 50 years, the tra­di­tional fix has been a trapeziec­tomy — the re­moval of the trapez­ium, a small bone that acts as a link be­tween the wrist and thumb. once re­moved, the space just fills with scar tis­sue.

Although it takes away the pain, it does not re­store the thumb’s strength, so sim­ple tasks such as re­mov­ing a lid from a jar will still be dif­fi­cult.

I do not of­ten rec­om­mend the al­ter­na­tive fus­ing oper­a­tion be­cause it is so re­stric­tive.

About four years ago, I was ap­proached by a U.S. com­pany which had de­vel­oped a syn­thetic car­ti­lage im­plant called Cartiva. rather than tak­ing out the trapez­ium, the im­plant acts as a cush­ion in the joint, so the bones no longer rub and cause pain.

I was asked to carry out some clin­i­cal tri­als on it at our hand unit, along with four other NHS trusts. over two years, our find­ings showed that this new im­plant was more than 90 per cent suc­cess­ful.

It is cylin­dri­cal and about 1cm wide with a curved top and an outer shell made of polyvinyl al­co­hol (PVA) — a rub­bery sub­stance the body tol­er­ates well.

for the 45-minute oper­a­tion, the pa­tient is awake, but their arm is numbed. I make a 1.5 in in­ci­sion on the back of the thumb and then move two ten­dons to the side so I can see the joint. I cut the lin­ing around the joint — the cap­sule — to ac­cess the bot­tom of the first metacarpal (first thumb bone).

I drill an 8 mm hole into the metacarpal and slot the im­plant into it snugly; the ex­posed, slightly rounded, top of the im­plant re­places the lost car­ti­lage. then I sew up the cap­sule and the skin us­ing a sin­gle dis­solv­able stitch.

the pa­tient goes home the same day, with a ban­dage cov­er­ing the thumb and wrist. this stays on for ten days. Af­ter this, phys­io­ther­apy will help to strengthen the thumb. Usu­ally, the pa­tient can re­turn to driv­ing in about four weeks.

In the three to six months af­ter surgery, they will feel the strength re­turn­ing and it will soon be as good as some­one who does not have arthri­tis. Af­ter a year, I would ex­pect it to be fully re­cov­ered.

Cartiva is suit­able for any­one ex­cept pa­tients with se­vere (stage four) arthri­tis, where the joint is too damaged to take an im­plant.

It is be­ing rolled out at more hos­pi­tals and I hope in fu­ture it will be the way we treat ev­ery­one with arthri­tis in their thumbs.

Pic­tures: DAMIEN MC­FAD­DEN / INK DROP / ALAMY

Pain-free: Bob Stafford

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