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Poster Presenter Ascorbic Acid Reduces CRPS Type I In 40 Consecutive Basal Thumb Joint Replacements Paul E. Zollinger, Maarten L. Ellis, Wim E. Tuinebreijer, Halil Ünal The Netherlands Complex regional pain syndrome (CRPS) type I may occur (mostly in females) as complication in trapeziometacarpal surgery (8-19%). Therapy is difficult, which makes prevention important. We investigated the results after vitamin C prophylaxis. Patients with trapeziometacarpal arthritis underwent joint replacement with a semi-constrained hydroxy-apatite coated prosthesis (type Roseland, Depuy International Ltd; Leeds, England). First web opening and visual analogue scale (VAS) scores for pain, activities of daily living (ADL) and satisfaction were taken perioperatively. Two days prior to surgery 500 mg ascorbic acid was started during 50 days as prevention for CRPS. We performed 40 implantations in 34 patients (mean age 61 years; 27 females, 7 males; mean follow-up of 44 months). First web opening increased with 15 degrees and there was a significant improvement for pain, ADL and satisfaction as well (p = 0.000). Patient satisfaction was strongly associated with the amount of pain reduction. According to the IASP and Veldman criteria no CRPS was found. In this prospective prosthetic cohort no
CRPS occurred after 500 mg vitamin C daily. Torrededia (2006) reported
5 cases of CRPS after 38 operations with the same implant (13%).
We advise vitamin C as prophylaxis against CRPS in this type of
hand surgery. |