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.
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.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.