Ligament Reconstruction and Tendon Interposition (LRTI) surgery is a common procedure performed to address debilitating thumb arthritis. This article provides a comprehensive overview of the time commitment involved, from the surgical procedure to the full recovery journey, helping patients prepare and manage expectations.
What is LRTI Surgery?
LRTI, or Ligament Reconstruction and Tendon Interposition, treats advanced arthritis at the base of the thumb (carpometacarpal or CMC joint arthritis). This condition occurs when cartilage cushioning the bones in the thumb’s CMC joint wears away, leading to pain, swelling, and reduced function. The procedure aims to alleviate pain and restore stability and motion to the arthritic thumb joint.
During LRTI surgery, the surgeon removes all or part of the trapezium bone at the base of the thumb. A portion of a nearby tendon, often the flexor carpi radialis (FCR) from the forearm, is harvested to create a cushion and reconstruct the damaged ligament. Part of this tendon rebuilds the thumb’s supportive ligament, while another portion is placed into the space where the trapezium was removed. This interposition of tendon tissue provides a new, smooth surface for the thumb metacarpal, stabilizing the joint and reducing friction.
How Long is the Surgery Itself?
The actual time in the operating room for LRTI surgery typically ranges from 60 to 90 minutes. The procedure involves precise actions such as removing the arthritic bone, preparing the tendon graft, reconstructing ligaments, and interposing the tendon into the joint space.
Several factors can influence the precise length of the operative time. The complexity of an individual case plays a significant role; for instance, more severe arthritis or unique anatomical considerations might require additional surgical attention. Whether other procedures, such as a carpal tunnel release, are performed concurrently can also extend the surgical duration. The surgeon’s experience and whether a surgical trainee is involved in the procedure may also impact the overall time spent in the operating room.
The Full Surgical Day
While the surgical procedure is relatively short, the entire experience on the day of surgery involves a longer time commitment at the surgical facility. Patients typically spend 4 to 6 hours at the hospital or outpatient surgical center from arrival to discharge.
The surgical day begins with check-in and pre-operative preparation, which includes changing into a gown, having an intravenous (IV) line inserted, and meeting with nurses, the anesthesiologist, and the surgeon. Anesthesia induction follows, preparing the patient for the procedure. After the surgery is complete, patients are moved to the Post-Anesthesia Care Unit (PACU) for immediate recovery, where vital signs are monitored as they awaken from anesthesia. The time spent in the PACU can be an hour or longer, depending on the type of anesthetic used and how quickly the patient recovers. Once stable, pain is managed, and discharge instructions are provided, patients are released to go home, completing their full surgical day.
Recovery Timeframes
The recovery period following LRTI surgery extends beyond the surgical day, encompassing several phases of healing and rehabilitation. Immediately after surgery, the hand and wrist are immobilized in a splint or cast for four to six weeks to protect healing tissues. During this initial period, elevate the hand to minimize swelling, and manage pain for comfort.
Physical therapy typically begins after the immobilization period, often around six to eight weeks post-surgery, focusing on regaining range of motion and strength in the thumb and wrist. While some light daily tasks, such as computer use, might be possible within days, patients are generally advised to avoid rigorous activities, forceful gripping, and heavy lifting for three to four months.
Full recovery of strength and function can be a gradual process, sometimes taking one to two years to achieve maximum improvement. Individual recovery times can vary based on factors such as adherence to therapy, overall health, and the body’s natural healing capabilities.