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Artificial trapeziometacarpal (TMC) joint replacement for end-stage osteoarthritis

Guidance issued Guidance issued
 
IP Guidance Number: IPG111
 
Summary:

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on artificial trapeziometacarpal (TMC) joint replacement for osteoarthritis.

Description:

Osteoarthritis of the hand joints is a common condition that deteriorates over time, although severity of symptoms, rate of deterioration and functional effects are variable. Common sites of osteoarthritis that may be suitable for artificial implants include the trapeziometacarpal (TMC) joint of the thumb (also called the carpometacarpal joint), and metacarpophalangeal and interphalangeal joints of the fingers and thumb.

Conservative treatments for osteoarthritis of the hand include anti-inflammatory and analgesic medication, and steroid injections. Other treatments for more severe disease include joint excision without replacement (excision arthroplasty), native graft arthroplasty (the patient's own tissue is interposed in the space left after joint excision) and fusion of the joint (arthrodesis).

To insert an artificial TMC joint, a general anaesthetic is usually used and a tourniquet is applied to the affected arm to maintain a blood-free operation site. An incision is made over the disease joint and the joint is removed. An artificial joint, typically made of a silicone based material, is inserted in place of the original joint. Local anaesthetic may be injected into the surgical area or into the arm at the end of the operation. The incisions are sutured and a splint is applied.

Arrangements:

Other (see guidance)

Topic Area:

Musculoskeletal

Specialty:

Plastic surgery
Rheumatology
Trauma and orthopaedic surgery

Specialist advice has
been sought from:
British Society for Surgery of the Hand
Date notified to NICE: 01 April 2002
Provisional Consultation Date: November 2004
Guidance Publication Date: 23 February 2005
Contact Details:
Project Manager
(for general enquiries or comments)
Ben Doak
ip@nice.org.uk
Technical Lead
(for procedure specific enquiries or comments)
Helen Gallo
ip@nice.org.uk
Contact Address:

Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA


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