Clinical Results of 40 Consecutive Basal Thumb Prostheses and No CRPS Type I After Vitamin C Prophylaxis

Abstract

Complex regional pain syndrome (CRPS) type I may occur as complication after any type of surgery for basal joint arthritis of the thumb. We investigated prospectively in an ongoing study our results after a fully standardized treatment with a total joint prosthesis under vitamin C prophylaxis.Patients with trapeziometacarpal arthritis stage II or III according to Dell, and no benefit from conservative treatment, were selected to undergo joint replacement with a semi-constrained hydroxyapatite coated prosthesis.First web opening and visual analogue scale (VAS) scores for pain, activities of daily living (ADL) and satisfaction were taken pre and postoperatively. Vitamin C 500 mg daily was started two days prior to surgery during 50 days as prevention for CRPS. Post-operative treatment was functional.We performed 40 implantations for trapeziometacarpal arthritis in 34 patients (mean age 60.8 years; 27 females, 7 males) with a mean follow-up of 44 months. Operations were performed in day care under regional (or general) anesthesia.First web opening increased with 15.4 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 Veldman and IASP criteria, there were no cases of CRPS.The overall complication rate for this procedure is high. Literature reports 5 cases of CRPS after 38 operations with the same implant (13%). We advise vitamin C as prophylaxis against CRPS in trapeziometacarpal joint replacement.

The role of vitamin C in the treatment of pain: new insights

“…Calcitonin + 3 g/day vitamin C (N = 11) for 2 weeksii. Pain relief in 73%, marked ↓ pain in 45%Uncontrolled prospective Arthritic joint replacement surgery [54] a 500 mg/day oral vitamin C (N = 34) for 50 days0% CRPS cases Paget’s disease of bone [58]3 g/day oral vitamin C (N = 16) for 2 weeks↓ Pain in 50%, no pain in 20% (within 5-7 days)Case report Rheumatoid arthritis [56]50 g IV vitamin C twice/week for 4 weeksBefore: 100% pain (QLQ)After: 0% pain IV intravenous, VAS visual analog scale, QLQ quality of life questionnaire*  P  < 0.05 a Study was included in CRPS meta-analysis [48–52] …”

“…Patients undergoing joint replacement surgery for osteoarthritis were administered 0.5 g/day prophylactic vitamin C for 50 days post-surgery (Table 1) [53, 54]. Although osteoarthritis of the carpometacarpo joint can be complicated by CRPS, no cases of CRPS were observed under vitamin C prophylaxis.…”

Efficacy and Safety of High-dose Vitamin C on Complex Regional Pain Syndrome in Extremity Trauma and Surgery—Systematic Review and Meta-Analysis

“…One of the 12 articles, which came from the Cochrane Database, was a proposed systematic review protocol and not an actual clinical trial. Another was a case series without control or placebo group (15). One was a secondary analysis of the same authors' previous study or cohort (16).…”

Complex Regional Pain Syndrome in Children: Asking the Right Questions

“…is there need for preventive measures? Vitamin C has been used to reduce the incidence of CRPS in adults with fracture and orthopedic surgeries (60)(61)(62). Without solid data regarding the incidence of CRPS in children, judging the need for routine use of vitamin C or other pre-emptive treatments is not feasible.…”