Hand Surgeons in an Aging Society

By Naoki Kato, MD, PhD

Japan’s aging rate (the ratio of the population aged 65 and older to the total population) has reached almost 28%, which is ahead of any other country in the world. The opportunity to provide medical care for these elderly people has increased dramatically in daily clinical consultation. All the elderly Japanese are covered financially by national health insurance, so we do not pay attention so much to whether they can afford to accept medical care. What we should take into account when making a decision about adequate treatment for the elderly hand disorder is how they use their hand in their daily living. Some of the elderly patients might walk with a cane and some might support their body up on their arms due to disability of their legs. For these actions, stability of the hand would be much more important than joint range of motion. For example, LRTI arthroplasty is considered to be one of the most popular surgical treatment for the thumb basal arthritis. Actually, I myself have performed this procedure for many patients regardless their ages. However, I can’t find the answer to which would be adequate procedure, between arthroplasty and arthrodesis, for the elderly, especially when they use walking canes? I have experienced some elderly patients showing painful thumb flexion/adduction deformity with MP joint hyperextension after LRTI arthroplasty. I presume LRTI would be unstable for the patients who use their hand as weight bearing upper extremity. In this point of view, arthrodesis would be better surgical procedure for thumb basal arthritis especially for the elderly who use walking cane. Rigid arthrodesis, which does not require external splint after operation, could be one of the solutions for this question.

Naoki Kato, MD, PhD
Hand Surgery Center
National Hospital Organization Murayama Medical Center
Tokyo, Japan