How Long Does LRTI Surgery Take From Start to Finish?

LRTI surgery for thumb basal joint arthritis typically takes between roughly 65 and 90 minutes of actual operating time, though the range can stretch wider depending on technique details and whether additional procedures are performed at the same time. Multiple studies place the average somewhere in that window, with one reporting a mean of about 66 minutes and another randomized trial recording a mean closer to 91 minutes.¹² But “start to finish” means more than just the cut-to-close time. When you factor in anesthesia setup, pre-operative preparation, and recovery room monitoring, your total time at the surgical facility is considerably longer than the operation itself.

What the Operating Time Numbers Actually Mean

When surgeons and researchers report operative time, they usually mean the interval from the first incision (or tourniquet inflation) to the final skin closure. That number does not include the time you spend in pre-op getting an IV placed, having your arm marked, and receiving your anesthesia block, nor the time afterward in the recovery area. For LRTI specifically, several studies give a useful picture of what the surgical portion takes. A large comparison study found LRTI averaged about 71 minutes, while a randomized controlled trial measured a mean of 91 minutes.² Another study focusing specifically on cost variation reported a mean of about 66 minutes.¹ The spread exists because LRTI is not a single standardized recipe. Different surgeons use different tendon sources, different fixation methods, and varying amounts of bone removal, all of which affect how long the procedure takes.

Why the Range Is So Wide

The classic LRTI procedure involves several distinct stages: removing all or part of the trapezium bone at the base of your thumb, harvesting a tendon from your forearm, threading that tendon through a bone tunnel in the metacarpal, and packing the remaining tendon into the space left by the removed bone to act as a cushion. Some surgeons remove the entire trapezium, while others take only the lower half.³ A partial removal naturally takes less time than a full one. The tendon harvest itself can vary: some techniques use only half of the flexor carpi radialis tendon, while others take the entire tendon and use a screw to anchor it, adding a step. These modifications exist because surgeons have been refining the procedure for decades, and each variation changes the clock.

Concurrent procedures are another major factor. Many patients with thumb basal joint arthritis also have carpal tunnel syndrome, and surgeons sometimes release the carpal tunnel ligament during the same operation. When this is done through the same incision rather than a separate one, it can actually add minimal time while avoiding the need for a second surgery later.⁴ A prospective study comparing single-incision versus double-incision approaches for combined basal joint arthroplasty and carpal tunnel release found the single-incision method was significantly shorter, with comparable outcomes and fewer complications like pillar pain.⁵ If your surgeon is adding carpal tunnel release, trigger finger release, or other hand procedures to the same session, your total operating time will be longer than the numbers reported for LRTI alone.

Does Having a Trainee in the Room Slow Things Down?

This is a reasonable worry if you are having surgery at a teaching hospital. A propensity-matched study looking at hand surgery procedures found that total operative times were essentially identical whether a resident was involved or not, about 76 minutes versus 74 minutes with no statistical difference.⁶ Short-term complication rates were also comparable. So the presence of a surgical trainee assisting your surgeon should not meaningfully change how long you are on the table.

Your Total Time at the Facility

If your operating time is somewhere around 65 to 90 minutes, your full visit will typically run three to five hours. The extra time breaks down into pre-operative preparation, the anesthesia process, and post-operative monitoring. Most LRTI surgeries are done under regional anesthesia, meaning a nerve block that numbs your arm, sometimes combined with sedation. Setting up a regional block and confirming it has taken full effect usually adds 20 to 40 minutes before the surgery itself begins. You will also spend time with nurses going through a pre-surgical checklist, getting your surgical site confirmed and marked, and having monitoring equipment placed.

After the operation, you move to a recovery area where staff check your vital signs, manage pain, monitor for nausea, and make sure you can walk steadily before sending you home. A widely used discharge scoring system evaluates things like stable blood pressure and heart rate, pain levels, alertness, absence of nausea, and ability to walk without difficulty.⁷ Most people meet these criteria within one to two hours after hand surgery, but regional anesthesia can sometimes take longer to wear off, which may extend your stay slightly. LRTI is almost always an outpatient procedure, so you go home the same day.

Anesthesia Choices and How They Affect the Timeline

The type of anesthesia you receive can shift the total time at the facility in ways that might not be obvious. General anesthesia requires intubation and deeper monitoring, which adds time on both ends. Regional nerve blocks (typically a brachial plexus block) avoid those steps but require time for the block to set up. A newer approach called WALANT (wide-awake local anesthesia, no tourniquet) uses local anesthetic with epinephrine injected directly into the surgical area. A systematic review of the WALANT technique found that while the actual operative time can run slightly longer because the surgeon does not use a tourniquet to create a bloodless field, total patient time in the operating room tends to be shorter and patients are discharged more quickly compared to general anesthesia.⁸ WALANT is gaining popularity for many hand procedures, though its use specifically for LRTI is still surgeon-dependent. The trade-off is that you are fully conscious and can feel pressure (though not pain) during the operation, which some patients find uncomfortable.

How LRTI Compares to Newer Alternatives

If you are researching LRTI, you have probably come across suture suspension arthroplasty and suture-button suspensionplasty as alternative procedures for thumb basal joint arthritis. These newer techniques generally take less time in the operating room. One randomized trial found suture-button suspensionplasty averaged 63 minutes compared to 91 minutes for LRTI.² A comparison study found that suture suspension cases had significantly lower tourniquet time, procedure length, and total time in the operating room than LRTI cases.⁹ Another multi-technique comparison placed LRTI in the middle at about 71 minutes, with simple suture suspensionplasty shorter at about 63 minutes and suture tape-based reconstruction longer at roughly 103 minutes.¹⁰

The reason for the time difference is straightforward: LRTI requires harvesting a tendon from your forearm and threading it through a bone tunnel, steps that suture-based techniques skip entirely. Whether the shorter operative time matters to you depends on your priorities. Some surgeons still prefer LRTI because it has the longest track record of published outcomes and they are comfortable with the technique. The shorter procedures also tend to come with shorter immobilization periods afterward, roughly two weeks in some suture suspension protocols versus six or more weeks for traditional LRTI, which affects your return to normal life more than the extra 20 or 30 minutes on the operating table.²

Immobilization After LRTI

The surgery itself is only the beginning of a long recovery, and the immobilization period is the first thing you will notice. A traditional LRTI protocol involves a thumb-spica splint for the first week, followed by a forearm-based thumb-spica cast for about five weeks, and then a custom thermoplastic splint for another six weeks after that.¹¹ That adds up to roughly three months of some form of immobilization, which is one of the most common complaints patients have about LRTI.

There is growing evidence that shorter immobilization may work just as well, however. A systematic review of post-arthroplasty immobilization found that studies comparing shorter versus longer casting periods showed no significant differences in patient-reported outcomes or pinch strength. In one study, starting active motion at four weeks produced results comparable to starting at six weeks. Another found that immobilizing for just a few days in a cast followed by a thumb-spica orthosis for four weeks was equivalent to two weeks in a cast followed by six weeks in an orthosis.¹² This is an area where practice is evolving, and your surgeon’s preference will drive what you actually experience. It is worth asking about, because the difference between four weeks and twelve weeks of restricted thumb use is enormous in daily life.

When You Get Your Strength Back

One of the more frustrating parts of LRTI recovery is that your hand will actually feel weaker before it feels stronger. Grip and pinch strength typically drop at the three-month mark compared to where they were before surgery.¹³ This makes sense when you consider that a tendon was removed from your forearm and your thumb base was completely reconstructed, but it can be discouraging when you are several months out from surgery and your hand feels weaker than it did with arthritis. Pain, on the other hand, tends to improve relatively quickly, with significant pain reduction often noticeable within two months.¹⁴

The strength recovery curve follows a predictable pattern. It takes about six months to get back to your pre-surgery grip and pinch strength, and roughly twelve months to see meaningful improvement beyond baseline.¹³ Grip strength was significantly better by the six-month point in another study tracking the same trajectory.¹⁴ The encouraging finding is that improvements do not plateau at one year. A study following patients for an average of five years found that hand strength, thumb motion, and functional scores continued to improve between the one-year and five-year marks. Pinch strength and functional questionnaire scores showed statistically significant gains during that later window.¹⁵ So while the first year can feel slow, the trajectory keeps going up.

What the Randomized Trial Said About Getting Back to Normal Activity

The randomized trial comparing LRTI to suture-button suspensionplasty offers one of the clearest data points on return to normal activity: LRTI patients resumed their usual activities at about 12 weeks on average, compared to 10 weeks for the suture-button group. LRTI patients also required more physical therapy sessions.² Twelve weeks to return to normal activity is three months, and that aligns with the immobilization timelines discussed above. It is important to note that “normal activity” here does not mean heavy manual labor or competitive sports. Full functional recovery with meaningful strength gains takes closer to six to twelve months, and continued improvement can stretch out to several years.

Planning Your Day Around the Procedure

If you are trying to figure out what surgery day actually looks like, here is a practical timeline. You will probably be asked to arrive one to two hours before your scheduled surgery time for check-in, paperwork, IV placement, and the anesthesia block. The surgery itself will take roughly an hour to an hour and a half. Recovery room time typically runs one to two hours, sometimes a bit longer while the nerve block wears off enough for the staff to assess your pain levels. Plan for a total of four to six hours at the surgical center, and make sure you have someone to drive you home since you will not be cleared to operate a vehicle.

You will leave with your hand in a bulky splint, prescriptions for pain medication, and instructions about keeping your hand elevated. Most surgeons schedule a follow-up visit within the first week or two to check the incision and transition to the next phase of immobilization. The surgical day itself is the shortest part of the LRTI experience. The weeks and months that follow, with casting, splinting, hand therapy, and gradual strengthening, are where the real time investment happens.