Abstract
Background
Thumb carpometacarpal (CMC) joint arthritis is a common and limiting condition of
the hand in the elderly population. This can often lead to Z-deformity and compromised
grip strength. While prosthetic arthroplasty has improved treatment outcomes, patients
with low bone stock still present technical challenges. Standard techniques may risk
poor implant positioning, fracture, and loosening. This case report describes the
use of a novel technique with the use of a patent-specific three-dimensional (3D)-printed
guide to enhance surgical precision.
Case Description
A 77-year-old female with Eaton stage IV CMC arthritis presented with advanced trapezium
collapse, adduction, and Z-deformity of her left thumb. Preoperative computed tomography
scan revealed a severely compromised trapezium with a medium height of 7 mm. A custom
3D-printed polylactic acid guide was designed to optimize cup positioning for MAÏA
prothesis implantation. Accurate guidewire placement was obtained through the use
of the 3D-printed guide, reducing the risk of malposition. Postoperative imaging confirmed
correct implant alignment without lucency at 12 weeks' postoperative.
Literature Review
In previous studies, the use of 3D-printed guides show reduced intraoperative time
and errors. However, challenge remains on the widespread adoption of the method, due
to increased cost and high production time outside the operating room.
Clinical Relevance
This case illustrates that 3D-printed patient-specific guides may enhance implant
placement accuracy in CMC arthroplasty, particularly in patients with compromised
bony anatomy. The guide facilitated safer reaming of the trapezium and optimized long-term
implant stability. Despite concerns about cost, production time, and required technical
expertise, such technology holds promise for select, high-risk cases.
Keywords
thumb - arthritis - arthroplasty - 3D-printing
