Thumb arthritis, particularly at the carpometacarpal (CMC) joint at the base of the thumb, is a prevalent condition that can hinder daily activities. This joint connects the thumb’s metacarpal bone to the trapezium bone in the wrist, enabling a wide range of motion for gripping and pinching. Over time, the protective cartilage can wear away, leading to pain, stiffness, and reduced function. When non-surgical treatments like splinting, medication, or injections no longer provide adequate relief, surgery becomes an option to alleviate discomfort and restore thumb utility.
Common Surgical Procedures
Several surgical procedures are available to address thumb arthritis, each involving distinct approaches to alleviate pain and improve function.
Trapeziectomy
One frequently performed option is a trapeziectomy, which involves removing the trapezium bone from the base of the thumb. This procedure aims to eliminate the painful bone-on-bone friction that occurs in an arthritic joint. After the trapezium is removed, the space may be left empty, or a tendon from the patient’s forearm can be used to create a cushion or suspend the thumb’s metacarpal bone. This technique, known as ligament reconstruction and tendon interposition (LRTI) or suspensionplasty, helps stabilize the joint and prevent shortening of the thumb.
Arthroplasty
Another surgical choice is arthroplasty, or joint replacement, which involves replacing the damaged joint surfaces with an artificial implant or a tendon graft. Some arthroplasty techniques remove the trapezium bone and replace it with a patient’s own tendon, which is then rolled into a ball and placed into the void, creating a cushioned joint. Alternatively, prosthetic implants made of materials like metal or ceramic can be used to reconstruct the joint, similar to how hip or knee replacements function. These implants restore smooth movement and alleviate pain.
Arthrodesis
Arthrodesis, or joint fusion, is a procedure where the bones of the CMC joint are permanently joined together, eliminating all movement in that specific joint. This technique involves removing the joint surfaces and then using metal wires, screws, or plates to hold the bones in place until they fuse into a single, solid unit. While fusion results in a stable and pain-free thumb, it does mean a loss of mobility. This option is considered for younger, active individuals who require significant thumb strength for their occupation or lifestyle, or in cases where other surgical methods have not been successful.
Osteotomy
An osteotomy involves reshaping the bone to realign the joint and redistribute stress, thereby preserving the joint itself. For thumb CMC arthritis, a closing-wedge osteotomy of the first metacarpal bone can be performed to correct the load axis and stabilize the joint. This method is less commonly applied to the CMC joint compared to other procedures but can be combined with ligament reconstruction to improve joint stability and potentially slow the progression of arthritis. This approach aims to reduce pain by improving the mechanical alignment of the joint.
Determining the Right Surgical Approach
Choosing the most appropriate surgical approach for thumb arthritis is a highly individualized decision, as no single procedure is universally suitable for everyone.
The severity and stage of arthritis play a significant role in guiding this choice. Early-stage disease may allow for joint-preserving options, while advanced degeneration often necessitates joint removal or replacement. The extent of cartilage damage and any associated joint instability are carefully assessed through imaging and physical examination.
A patient’s age, activity level, and lifestyle also influence the surgical recommendation. Younger, more active individuals who place high demands on their hands might benefit from procedures that prioritize strength and long-term durability, such as arthrodesis, even if it means a loss of some motion. Conversely, older individuals or those with lower functional demands might prioritize pain relief and a quicker recovery. Overall health and any existing medical conditions are also considered to ensure the patient can safely undergo surgery and effective recovery.
The patient’s specific goals and expectations for pain relief and functional improvement are central to the discussion. Some individuals may prioritize regaining fine motor skills, while others may focus on eliminating pain during heavy gripping. The surgeon’s experience and preference for certain techniques, along with whether other joints in the hand are also affected by arthritis, contribute to the decision-making process. A thorough discussion with a qualified orthopedic surgeon is essential to weigh these factors and select the most suitable surgical plan.
Recovery and Long-Term Outlook
Following thumb arthritis surgery, the immediate post-operative period involves immobilization of the thumb and wrist in a splint or cast. This initial immobilization, lasting several weeks, protects the surgical site and allows for initial healing. Pain is managed with prescribed medications, and wound care instructions prevent infection. Elevating the hand helps reduce swelling and discomfort.
Rehabilitation is a key part of recovery, often beginning with gentle range-of-motion exercises once initial immobilization concludes. Physical or occupational therapy guides patients through exercises to regain strength, flexibility, and function in the hand and thumb. Recovery timelines vary by procedure and individual healing rates; initial healing typically occurs within a few weeks. Full recovery, including return to strenuous activities, can take several months, often three to six months or longer.
Long-term outcomes generally include significant pain relief and improved ability to perform daily activities. Most patients experience reduced discomfort and increased grip and pinch strength. While the goal is to restore function, some residual stiffness or altered sensation around the surgical site can occur. Potential complications include nerve irritation, infection, or persistent stiffness, but most individuals report positive results and satisfaction with their surgery.