Mini Power Saw Technique Cuts Operative Time in First CMC Arthroplasty: Case Report Highlights Surgical Innovation
USA: A new case report published in the Journal of Medical Case Reports by Jay Garvey and Scott Gargasz from the Advanced Hand and Plastic Surgery Center in Tampa, Florida, highlights a promising modification to first carpometacarpal (CMC) Ensemble arthroplasty that can enhance surgical efficiency. The use of a mini power saw blade in place of the traditionally time-intensive manual rasping technique reduced operative time by 20 minutes without compromising patient outcomes.
First CMC osteoarthritis is a common degenerative condition affecting the base of the thumb, often resulting in significant pain and loss of function. Traditional surgical intervention for this condition—Ensemble arthroplasty—relies heavily on manual rasping to shape the trapezium and the base of the first metacarpal. While effective, this approach is both time-consuming and carries a risk of nerve injury due to repeated instrumentation near the dorsal radial sensory nerve branches.
In this case, a 56-year-old Caucasian woman with advanced first CMC osteoarthritis presented with chronic thumb pain and limited mobility. She had previously undergone several corticosteroid injections, which provided only temporary relief. Seeking a long-term solution, the patient opted for surgical intervention after conservative treatments failed to manage her symptoms effectively.
Radiographic imaging confirmed severe joint space narrowing and osteophyte formation. During the procedure, the surgical team modified by incorporating a mini power saw blade to assist in joint space preparation, specifically to reduce a prominent medial bone spur. This tool was used alongside the manual rasp, offering more precise and efficient bone contouring. Intraoperative fluoroscopy confirmed the optimal positioning of the implant.
The patient’s postoperative recovery proceeded as expected. She began occupational therapy two weeks after surgery, attending two to three sessions per week. Her outcomes were comparable to those typically achieved with the conventional rasping technique.
According to the authors, this approach not only shortened the overall operative time but also has the potential to improve surgical safety by reducing repetitive handling near sensitive nerve branches. The use of a mini power saw could streamline a portion of the procedure that is otherwise labor-intensive and technically challenging.
While thi case represents an early step in exploring the benefits of this innovation, the findings suggest that incorporating powered instruments in the first CMC arthroplasty may help optimize efficiency without sacrificing precision or patient results. The authors note that further research and larger studies will be needed to validate these initial results and better understand the technique’s impact on surgical practice and long-term patient recovery.
Reference:
Garvey, J., Gargasz, S. Time reduction with a mini power saw blade in first carpometacarpal Ensemble arthroplasty: a case report. J Med Case Reports 19, 281 (2025). https://doi.org/10.1186/s13256-025-05351-7
