Combination of Denervation with Autologous Fat Transfer (CoDRAFT): A Novel Technique and Outcomes in the Treatment of Thumb Carpometacarpal Arthritis

OBJECTIVE: Selective denervation and autologous fat transfer are both effective approaches at alleviating pain and disability in carpometacarpal arthritis. While each has independently proven to be an efficacious treatment, the combination of both procedures simultaneously to treat trapeziometacarpal joint osteoarthritis has not been previously described and thus outcomes are not currently known. The objective of this study is to present outcomes of patients who simultaneously underwent both procedures. METHODS: A retrospective review was conducted of patients who previously underwent both carpometacarpal denervation and autologous fat transfer for the treatment of basilar joint arthritis. Differences in preoperative and postoperative pain at rest and with activities using the numeric rating scale, patient-reported changes in strength and range of motion, and any complications from the procedure were reviewed. RESULTS: Five patients underwent combination of denervation and autologous fat grafting for the treatment of carpometacarpal arthritis (Eaton-Littler classification stages II & III). All of the patients were female, average age of 54, and had failed conservative management. With an average follow up time of nine months, all patients reported some improvement in their pain at rest and with daily activity. Preoperatively, the average reported pain at rest and with activity for the cohort were 5.2 and 7.8 while the averages postoperatively were 1.2 and 3.8, respectively. Two patients reported subjective improvements in thumb pinch strength and range of motion following the procedure, the other patients did report any discernible differences. Three of the five patients reported decreased pain medication use following their procedure. There were no complications. One patient, who reported only modest improvement in her pain, elected to undergo trapeziectomy with ligament reconstruction and tendon interposition which resulted in the resolution of her symptoms. CONCLUSION: Combination of denervation and autologous fat transfer is a safe procedure with promising efficacy in the treatment of carpometacarpal arthritis pain. The procedure is well tolerated and allows for a relatively fast recovery. Furthermore, patients are able to successfully undergo further reconstructive options such as trapeziectomy with ligament reconstruction and tendon interposition in the future. CORRESPONDING AUTHOR: Jacob Franke; [email protected]; 330 Barclay Ave NE #300, Grand Rapids, MI 49503; (618) 977-0363