Is the BioPro thumb insert a viable surgical option for thumb arthritis?

BioPro Thumb Insert for Thumb Arthritis

Surgery, including the BioPro thumb carpometacarpal hemiarthroplasty, is a viable option for severe thumb base osteoarthritis but should only be considered when conservative treatments have failed and the patient has marked pain and/or disability. 1

Surgical Options for Thumb Arthritis

• Surgery is clinically effective for severe thumb base OA refractory to conservative treatments, with multiple surgical techniques available including arthrodesis, trapeziectomy, and various joint replacement options 1
• The BioPro thumb implant is a modular, press-fit thumb CMC hemiarthroplasty prosthesis that permits minimal bone resection while sparing the trapezium 2
• This surgical approach allows for revision options if necessary, which is an important consideration in surgical planning 2

Evidence for BioPro Thumb Insert

• A recent (2024) case series of 11 patients who underwent BioPro thumb CMC hemiarthroplasty showed significant pain reduction from a median preoperative VAS score of 8/10 to 1/10 at median follow-up of 23 months 2
• In this study, 10 out of 11 patients (91%) showed good pain relief, function, and satisfaction at 12 months post-surgery 2
• 8 out of 11 patients reported they would recommend the surgery to others and would opt for the same procedure on their contralateral hand if necessary 2

Comparative Effectiveness of Surgical Options

• No surgical procedure for thumb base OA has demonstrated clear superiority over others in terms of pain relief, physical function, quality of life, or patient global assessment 1, 3
• Systematic reviews indicate that non-implant techniques (trapeziectomy, joint fusion, trapeziectomy with ligament reconstruction) generally have lower failure rates than implant arthroplasties 4
• Failure rates per 100 procedure-years: total joint replacement (2.4), hemiarthroplasty (2.5) vs. trapeziectomy (0.49), joint fusion (0.52), and trapeziectomy with ligament reconstruction (0.23) 4

Potential Complications and Considerations

• The BioPro implant has been reported to have a low risk of subluxation, but complications can occur 2
• In the case series, one patient (9%) experienced persistent pain due to improper implant placement and subsequently developed a trapezium fracture requiring revision surgery 2
• Failure of thumb CMC arthroplasty often requires revision surgery, which typically involves soft tissue interposition and distraction pinning to address metacarpal subsidence 5

Treatment Algorithm for Thumb Arthritis

1. First-line: Conservative management

   • Activity modification, education, heat application 6
   • Topical NSAIDs, oral analgesics (paracetamol up to 4g/day) 6
   • Exercise regimens for range of motion and strengthening 6

2. Second-line: Invasive non-surgical options

   • Corticosteroid injections for painful flares 6

3. Third-line: Surgical options when conservative treatments fail

   • Consider surgical options including the BioPro thumb insert when:
     • Patient has marked pain and/or disability 1
     • Conservative treatments have failed 1
     • Patient desires maintenance of joint mobility 2, 7

Important Caveats

• The EULAR guidelines specifically note that "the potential benefits of surgery compared with conservative management, and the most appropriate surgical procedure for thumb base OA, remain to be determined" 1
• While the BioPro thumb insert shows promising results in a small case series, larger comparative studies are needed to establish its long-term efficacy and safety profile compared to other surgical techniques 2, 7
• The quality of evidence for thumb CMC joint replacement is generally low, with only one randomized controlled trial identified in a 2021 systematic review 7
• Patients should be informed that failure rates for implant arthroplasties are generally higher than for non-implant techniques 4