Thumb Base Arthritis

Surgical Options for the Treatment of Thumb Basal Arthritis

Thumb basal arthritis, also known as carpometacarpal (CMC) joint arthritis, is a common

degenerative condition affecting the base of the thumb. It is particularly prevalent in middle-aged and older adults, especially women. The CMC joint allows for the thumb’s wide range of motion, but this mobility also makes it susceptible to wear and tear arthritis and when this happens surgical options might be appropriate when conservative treatments such as splinting, medications, and injections fail to provide relief. This document explores

the main surgical options for thumb basal arthritis, including trapeziectomy and suspensionplasty, neurectomy, fusion (arthrodesis), and joint replacement (arthroplasty).

Key is ensuring your surgeon is familiar with the type of procedure they are offering and achieves good outcomes. When there are multiple surgical options for a particular condition this usually means that each one has its own particular advantages and disadvantages or is best used in specific circumstances. I have outlined each procedure below including advantages and disadvantages.

Thumb basal arthritis can significantly impact hand function and quality of life. When conservative treatments are no longer effective, several surgical options are available, each with its own advantages and limitations. Trapeziectomy with suspensionplasty remains the gold standard for many patients, offering reliable pain relief and preservation of function. Neurectomy may be suitable for those seeking a less invasive approach, while fusion provides stability and strength at the expense of motion. Joint replacement is an option for those prioritising mobility, though implant longevity remains a unknown beyond about 12 years for the most modern implants but at present they appear to perform as well as knee joint replacements.

The choice of surgery is individualized, taking into account your needs, expectations,

and lifestyle. A thorough discussion with me can help determine the most appropriate

treatment plan, ensuring the best possible outcome for you.

You can download my document which goes through all of these options here

Trapeziectomy is the most commonly performed surgical procedure for thumb basal arthritis. It

involves the removal of the trapezium bone, which forms the base of the thumb joint. By removing this bone, the source of pain and inflammation is eliminated, and the bones are prevented from rubbing against each other.

Suspensionplasty is often performed in conjunction with trapeziectomy to stabilize the thumb and prevent the first metacarpal from collapsing into the space left by the removed trapezium. There are several techniques for suspensionplasty, but the most common is the ligament reconstruction and tendon interposition (LRTI) procedure. In LRTI, a portion of a tendon (usually the flexor carpi radialis or abductor pollicis longus) is harvested and used to create a sling or cushion in the space where the trapezium was removed.

Advantages:

Proven long-term pain relief and functional improvement.

Preserves thumb motion and strength.

Low risk of major complications.

Disadvantages:

Recovery can be lengthy, often requiring several weeks of immobilisation and hand therapy.

Some loss of pinch strength compared to a healthy thumb.

Potential for thumb shortening or instability.

Indications:

Patients with moderate to severe arthritis who have failed conservative management.

Those seeking to maintain thumb mobility and function.

Outcomes:

Most patients experience significant pain relief and improved function. Complications are relatively rare but can include infection, nerve injury, or persistent instability.

Joint replacement, or arthroplasty, involves replacing the damaged CMC joint with an artificial

implant. There are various types of implants, including silicone, metal, and pyrocarbon devices. The one which I use is very similar in structure to a total hip replacement with metal components in each bone and a mobile polethylene ball in the socket.

Advantages:

Preserves or restores thumb motion.

Can provide excellent pain relief and functional improvement.

May be preferable for younger, working patients who wish to maintain a high degree of thumb mobility or older patients who are still very active and participating in sports or hobbies.

Recovery and rehabilitation can be quicker than other procedures.

Pinch strength is better than trapeziectomy

Thumb shape and length remains normal

Disadvantages:

Risk of implant loosening, dislocation, or failure over time.

Potential for infection or allergic reaction to implant materials.

Revision surgery may be required if the implant fails - either to a larger implant, or to a trapeziectomy and suspensionplasty.

Indications:

Patients with advanced arthritis who desire to maintain thumb motion and are looking for an earlier return to work.

Those who have failed other surgical options or have contraindications to fusion.

Outcomes:

Joint replacement can offer good pain relief and improved function, but long-term results depend on implant design and patient factors. Younger, more active patients may experience higher rates of implant failure.

You can download my patient information about thumb joint replacement surgery here. If you want to see feedback from one of my patients about their thumb joint replacements - head to the testimonials section.

Fusion, or arthrodesis, involves surgically joining the bones of the CMC joint so that they knit together as a single bone and no longer move against each other. This eliminates pain by preventing motion at the arthritic joint.

Advantages:

Provides excellent pain relief.

Maintains thumb length and stability.

Suitable for younger, active patients or those with high physical demands or who have hypermobility conditions.

Disadvantages:

Loss of motion at the CMC joint, which can limit thumb movement and function.

Risk of nonunion (failure of the bones to fuse) or hardware complications.

Increased stress on adjacent joints, potentially leading to arthritis elsewhere in the hand.

Indications:

Patients with severe arthritis and instability.

Those who require strong pinch and grip strength for work or daily activities.

Outcomes:

Fusion is highly effective for pain relief and stability, but the loss of motion can impact fine motor tasks. Most patients adapt well, but careful patient selection is important.

Neurectomy is a less invasive surgical option that involves cutting the nerves that transmit pain

signals from the arthritic joint. The most commonly targeted nerve is the superficial branch of the radial nerve, which supplies sensation to the base of the thumb. It is not commonly performed but there are situations in which it may be preferable to bony surgery.

Advantages:

Minimally invasive with a short recovery period.

Can provide significant pain relief for selected patients.

Preserves joint structure and function.

Does not "burn any bridges" for future surgery to be undertaken

Disadvantages:

Does not address the underlying joint degeneration.

Pain relief may be temporary, and arthritis may progress.

Not suitable for patients with severe deformity or instability.

Indications:

Patients with mild to moderate pain who are not candidates for more extensive surgery.

Younger patients in whom bony procedures have disadvantages or may not be longlasting.

Those seeking a less invasive option with minimal downtime.

Outcomes:

Neurectomy can be effective for pain relief in carefully selected patients, but it is generally considered a palliative procedure rather than a definitive solution.