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Thumb base arthritis, also known as trapeziometacarpal arthritis, or thumb carpometacarpal (CMC) joint arthritis, is a common condition that affects the joint at the base of the thumb. It can cause significant pain and disability, impacting daily activities.
The joint at the base of your thumb, which is called the trapeziometacarpal or thumb carpometacarpal joint, plays a major role in many daily activities, including gripping, pinching, and grasping movements. The joint connects your thumb to the wrist and is responsible for providing the wide range of motion of the thumb; this can make it more susceptible to wear and tear as we age, leading to a condition known as osteoarthritis (OA).
In this article our expert hand and wrist surgeon Mr Sam Gidwani gives us a detailed insight into thumb base joint replacement surgery; its indications, benefits, and an explanation of the procedure, as well as postoperative rehabilitation protocols, and surgical outcomes.
Thumb base osteoarthritis occurs when the cartilage that cushions the ends of the bones in the CMC joint deteriorates. This leads to bone-on-bone contact, causing pain, inflammation and swelling, joint stiffness and loss of function.
Several factors contribute to the development of thumb base OA:
The symptoms of thumb base OA can vary in severity but typically include:
When conservative treatments (e.g., medications, injections, splinting, and physiotherapy) fail to provide good relief, thumb base joint replacement surgery, also known as CMC arthroplasty, may be a recommended option.
This involves removing the arthritic joint at the bottom of your thumb and replacing it with an artificial joint. There are different types of implants that can be used, but the most successful is a ball and socket implant that looks a bit like a hip replacement. It has a small stem that extends into the thumb bone and a cup that is implanted into the trapezium bone at the base of the thumb.
The ideal candidates for thumb joint replacement are individuals experiencing arthritis at the base of the thumb, who are wanting to regain enhanced functionality beyond what more traditional surgical interventions for thumb arthritis (such as a Trapeziectomy) can offer.
This operation is performed to relieve pain in the arthritic joint and improve your thumb and hand function. Surgeons will always encourage you to try conservative options like painkillers, steroid injections, splints, physiotherapy and activity modification before considering surgery. The majority of patients with thumb base arthritis can manage their symptoms in this way without ever needing an operation.
If surgical treatment is required, thumb joint replacement surgery offers specific benefits over more traditional methods, including:
All surgery comes with its risks and trade-offs. This form of joint replacement surgery comes with a risk of dislocation (3-4%) and gradual loosening over time. You will be given all the information you need to make an informed choice.
The main concern with thumb joint replacements is that it is a relatively new procedure compared to replacements of larger joints like the hip, and the technology of the implants is evolving. While there is some excellent literature and studies being carried out that suggests these replacements have demonstrated very good durability, longevity of the implants beyond 10 years is not yet fully known.
The procedure is almost always done as a day case, and usually takes about 60 to 80 minutes.
The recovery process following thumb base replacement surgery is usually straightforward and manageable. At around two weeks post op, your dressing will be removed and for most individuals they can slowly resume light daily activities such as washing, dressing, writing, typing, using kitchen utensils etc, as their pain settles. You will be given a splint to wear for another 4 weeks to allow for a period of immobilisation.
It’s advised that patients remain cautious for the initial six weeks following surgery; gradually increasing more strenuous activity from the sixth week onward. Heavy lifting should be avoided until approximately ten to twelve weeks post-surgery.
Thumb base joint replacement surgery has a high success rate, with most patients experiencing significant pain relief and improved function. Some of the expected outcomes include:
Surgery should only be considered as a last resort, when other interventions have failed. The initial approach to managing thumb base arthritis should be through activity modification, hand therapy, splints, steroid injection and other analgesics.
Unfortunately, as OA is a degenerative condition, it can often deteriorate over time and eventually a percentage of patients will require surgery.
As well as joint replacement surgery, another option for patients is a procedure called a Trapeziectomy. This involves the removal of the bone at the base of the thumb (trapezium) to stop the bones in the thumb joint rubbing together and causing pain. This has previously been the gold standard treatment option. However the recovery process can be lengthy, and while it alleviates the pain, it can leave the individual with reduced thumb strength.
Another option is a joint fusion, which involves permanently immobilising the joint. Again this helps significantly with pain, but it can cause functional limitations. It is generally used in very young patients who have developed osteoarthritis as a result of a joint injury or fracture.
Sam Gidwani is a Consultant Hand and Wrist Surgeon at Guy’s & St.Thomas’ Hospitals, and works privately at London Bridge Orthopaedics.
‘An outstanding surgeon who listened to my concerns and turned things around with incredible efficiency. I was in awe watching the skill in theatre and Mr Gidwani was a talent in making me feel at ease throughout surgery, while also having a great sense of humour whilst remaining professional with staff and patient. I look back on my time in theatre as an amazing experience and it was all down to Mr Gidwani. I cannot thank him enough.’
Thumb base arthritis can significantly impact quality of life, but thumb base joint replacement surgery offers a viable solution for those who do not find relief with conservative treatments. Understanding the causes, symptoms, surgical procedure, and post-operative rehabilitation protocols is essential for achieving the best outcomes.
With the expertise of surgeons like Mr. Sam Gidwani at London Bridge Orthopaedics, patients can look forward to improved function and reduced pain, enabling them to return to their daily activities with confidence.
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