Thumb Arthritis Surgery

What is Arthritis?

Arthritis is an inflammatory condition of the joints. There are several types of arthritis; the most common type is osteoarthritis, or wear-and-tear arthritis, which affects the joint at the base of the thumb. Thumb arthritis is more common in women than men and usually occurs after the age of 40 years. Patients with arthritis of the fingers may have swelling, pain, stiffness, and malformation, all of which interfere with the use of the hand.

Diagnosis of Thumb and Digit Arthritis

Your doctor can usually diagnose thumb arthritis by examining the thumb. X-rays of the joint may be taken to determine the severity of the disease and to determine any bone spurs or calcium deposits.

What is Thumb Arthritis Surgery?

Thumb arthritis surgery, also referred to as thumb basal joint arthroplasty or thumb carpometacarpal (CMC) arthroplasty, is a procedure aimed at alleviating pain and improving function in the thumb due to arthritis, particularly osteoarthritis. This type of arthritis most commonly affects the joint at the base of the thumb, which connects the thumb to the wrist, known as the carpometacarpal joint.

The surgery typically involves removing the arthritic joint surfaces and then reconstructing the joint to prevent bone-on-bone friction, which causes pain. One common technique is to remove the trapezium bone (one of the bones in the CMC joint) and replace it with a cushion of material that keeps the remaining bones separated. The cushion may be a portion of tendon taken from the patient's arm or wrist.

Who is Suitable for Thumb Arthritis Surgery?

Patients suitable for thumb arthritis surgery usually have severe symptoms that significantly impact their daily activities and have not responded well to non-surgical treatments. These non-surgical treatments include pain medications, anti-inflammatory drugs, splints, and corticosteroid injections.

Criteria for thumb arthritis surgery may include:

• Severe pain in the thumb that interferes with daily activities.
• Weakness and loss of ability to pinch or grip objects.
• Changes in the shape of the thumb or the hand.
• Failed response to non-surgical treatments.

Benefits of Thumb Arthritis Surgery

Thumb arthritis surgery can have several benefits:

• Pain Relief: The most significant benefit is typically a considerable reduction in pain. Many patients experience complete or near-complete relief from pain following recovery from surgery.
• Improved Thumb Strength: Surgical treatment can help restore thumb strength, making it easier to perform tasks that require pinching or gripping.
• Increased Range of Motion: The surgery can improve or restore the thumb's range of motion.
• Better Quality of Life: By reducing pain and improving thumb function, thumb arthritis surgery can make daily tasks easier and improve the patient's overall quality of life.

Types of Thumb Arthritis Surgery

There are several different surgical techniques for thumb arthritis, and these may include the following:

• Synovectomy: This surgery is usually indicated for early cases of inflammatory arthritis where significant swelling (synovitis) is causing pain or limiting the range of motion of the digits and thumb. Synovectomy is the surgical removal of the inflamed synovium (tissue lining the joint). The procedure may be performed using arthroscopy.
• Resection Arthroplasty: In this procedure, your surgeon removes one of the bones at the base of the thumb (trapezium). Commonly, part of the procedure involves a step where the surgeon suspends the long bone of the thumb (metacarpal) so that it does not sink into the space where the trapezium was. This type of arthroplasty is an example of excisional arthroplasty. It is known as trapeziectomy and ligament reconstruction and tendon interposition (LRTI)/suspensionplasty, depending on how your surgeon performs the second step.
• Arthrodesis: A fusion, also called an arthrodesis, involves removing the remaining cartilage from the bones of the affected joint, followed by joining the bones using metal wires or screws. Even though this surgery eliminates all motion at the base of the thumb, the resulting fusion is very hard. This surgery is usually indicated when the previous arthroplasty has failed or when heavy manual use is expected.

Your surgeon will discuss the options and help you decide which type of surgery is the most appropriate for you.

Alternative Options to Thumb Arthritis Surgery

Alternatives to surgery typically involve conservative treatments such as:

• Medications: Over-the-counter pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation.
• Splinting: Wearing a splint can support the thumb and wrist, relieving pain.
• Hand Therapy: Therapists can teach exercises to help improve the strength of the muscles supporting the thumb and hand and suggest modifications to daily activities to reduce stress on the thumb.
• Steroid Injections: Injecting a corticosteroid into the thumb joint can temporarily relieve pain and inflammation.

What to Do Before Thumb Arthritis Surgery?

Before the surgery, patients usually need to:

• Undergo a physical examination and other tests (like X-rays) to confirm the diagnosis and rule out other conditions.
• Discuss with the surgeon about the procedure, the expected outcomes, and the risks.
• Complete any necessary paperwork and pre-surgical assessments.
• Stop taking certain medications that could increase the risk of bleeding.
• Plan for recovery after surgery, which may include arranging for help at home, getting any necessary adaptive equipment (like hand splints), and planning for time off work.
• Follow any preoperative instructions from the surgeon, such as fasting before the surgery.

Thumb Arthritis Surgery Procedure

The exact process will depend on the specific surgical technique being used, but generally:

• The procedure will begin with the administration of anaesthesia. This could be general anaesthesia (where you're asleep for the surgery) or regional anaesthesia (which numbs only a portion of the body; in this case, the forearm, wrist and hand).
• Once the anaesthesia is effective, the surgeon will make an incision over the affected joint at the base of the thumb.
• The surgeon will then perform the planned procedure, which could involve removing the affected bone (trapeziectomy), reconstructing the joint with a tendon graft (LRTI) or synthetic material or fusing the joint (arthrodesis).
• After the procedure, the surgeon will close the incision with sutures and apply a bandage. A cast will be applied to protect the thumb and wrist and support healing.

Thumb Arthritis Surgery Recovery Plan

Typically, the recovery plan after thumb arthritis surgery includes the following:

• Pain management: This often involves medication to help control post-surgical pain.
• Wound care: Keep the surgical site clean and dry to prevent infection.
• Hand Therapy: A therapist will work with you to help you regain movement, strength, and function in the thumb and hand.
• Gradually resuming activities: As healing progresses, you can slowly return to normal daily activities. It's important to avoid overuse of the hand and thumb early in the recovery process.

The exact timeline for recovery will vary depending on the specific procedure and the individual patient, but full recovery can often take several months.

Thumb Arthritis Surgery Prognosis

Many patients experience significant pain relief and improved function after thumb arthritis surgery. However, seeing the full benefits of the surgery can take time as the recovery period can be long and involve rehabilitation.

Thumb Arthritis Surgery Risks

As with any surgery, thumb arthritis surgery comes with risks, including:

• Infection
• Bleeding
• Damage to nerves or blood vessels
• Complications related to anaesthesia
• Failure of the surgery to relieve pain or improve function
• Need for additional surgeries

What if Thumb Arthritis Surgery is Delayed?

Delaying surgery can lead to further joint damage and worsening of symptoms. Pain may become more difficult to manage, and loss of function and deformity may progress. However, surgery is typically considered only after conservative treatments have failed to provide adequate relief, so it's important to discuss the timing of surgery with your orthopaedic surgeon.