Surgery for thumb base arthritis can be either aimed at reducing inflamation and pain such as a debridement and denervation, or aimed at removing the souce of the pain in the case of Trapeziectomy or Joint Replacement.

A trapeziectomy is a procedure to completely remove the bane at the base of the thumb, this is often supplemented with LRTI (Ligament Reconstruction and Tendon Interposition). A trapeziectomy is a good operation for pain relief especially when there are arthritc changes in both the CMC and STT joints as this will address both areas simultaneously. Long term pain relief and function are generally very good however this does take a fair amount of time to get over. 

The surgery involves an incision over the base of the thumb, the trapezium bone is exposed and then fully removed, if there is also arthritic changes in the scaphotrapezoidal joint a small section of bone can also be removed from this. After removing the bone a strip of tendon is harvested from the forearm, leaving it attached in the hand. This is then passed through the metacarpal (thumb bone) and fixed, the remaining tendon is then used to fill the joint space. The wounds are close with disolvable stitches and you will be put into a short plaster splint.

After the operation you will see the hand therapist normally in 10 - 14 days, at that stage the plaster will come off and you will be given a thermoplstic splint to use. You should use this anytime you are not doing your exercises until 6 weeks following the operation.

Trapeziectomy is generally a good operation for getting rid of the pain however it can be uncomfortable for 3 months or more and will take may months to regain maximum strength. Whilst function is normally very good there is likely to be some reduction in grip strength.

Trapeziectomy and Ligament reconstruction

An incision is made over the joint and the capsule exposed, by elevating the capsule this will remove some of the nerves that supply the joint and this can help to reduce the pain. Any osteophytes (bony outgrowths that form with arthritis) can also be removed. This surgery can help to reduce the pain and can be useful in people who still have good function or do not feel ready for more extensive surgery, it does not however address the underlying problem of the arthritis and some residual pain and restricted function if likel, it is also likely that further surgery will be required in the future.

Joint Debridement

Carpometacarpal Joint Replacement

Thumb base replacement (carpometacarpal joint replacement) is an operation to replace the joint at the base of the thumb with a prosthetic joint. The surgery involves a cut over the base of the thumb, removing a small piece of bone from the base of the thumb bone (the metacarpal) and inserting a metal stem into the canal. A metal cup is then inserted into the small bone at the base of the thumb (the trapezium )finally a neck with a polyethylene ball is added to create a ball and socket joint. The skin is close with disolvable stitch and you will be put into a short plaster splint initially.

After the operation you will see the hand therapist at 10 - 14 days, at this stage the plaster will come off and you will be given a thermoplastic splint, you should use the splint at night and when out and about to reduce the risk of dislocation until the capsule has fully healed. You can start to mobilise the thumb as soon as you come out of the plaster and generaly people notice a good improvement in their pain after only a few weeks. You can start to get back to light activities after 3-4 weeks and by 6 weeks can return to all but high risk activities.

Whilst thumb joint replacements have been tried in many formats in the past there have been problems with high rates of failure. The new generation of replacements however are showing excellent short to medium term survival (up to 96% at around 7 years) and we expect around about 90% at 10 years. However as these designs have not been in use for that long we can not say for certain that they will.

You can watch a video of the surgery performed by Mr Read HERE if you wish