Nouveautés médicales et prise en charge chirurgicale dans l’arthrose digitale

Abstract

Hand osteoarthritis (OA) is a very frequent and heterogeneous disease. Its medical management is currently based on European recommendations and includes pharmacological (topical NSAIDs, and infiltrations) and non-pharmacological measures (orthotics, and ergonomics). Conventional synthetic or biological treatments used in rheumatoid arthritis have not demonstrated any efficacy. The only positive trial in recent years is low-dose corticosteroid therapy, which has demonstrated a suspensive effect. However, new therapeutic options such as botulinum toxin infiltrations or vagus nerve stimulation are currently being evaluated. As far as surgical treatment is concerned, arthrodesis remains the intervention of choice for distal interphalangeal OA and new fixation methods allow immediate mobilization. At the proximal interphalangeal level, joint denervation is an interesting conservative solution, while the best functional result is obtained with a prosthesis. The new models of resurfacing implants give higher amplitudes than hinged silicone implants, but we do not yet have the hindsight we have for the latter. For thumb base OA, trapezectomy with or without suspension ligamentoplasty has been confronted in recent years with severe competition from trapeziometacarpal prostheses, which allow faster functional recovery despite a higher complication rate and a long-term survival that is still poorly known. In total, surgical decision-making is based on multiple factors: functional demand of the patient, stability of the osteoarthritic joint, radiographic anatomical parameters.