Patients usually consider surgery for osteoarthritis of the base of the thumb when they have got to the point where the pain is making them miserable. This might be because they can no longer do the activities they want to do, such as sport, music or childcare; or if it's waking them up at night and making them dependent on painkillers.
At that point there are three main surgical options:
1) Thumb CMC joint fusion (arthrodesis surgery) which blocks movement at the CMCJ and so it can't cause pain. This is generally a stable and durable option, and usually requires only one operation. However, it means the thumb will always adopt an abducted resting posture, so the hand will not go flat on a table top in the future.
2) Trapeziectomy - surgery to take out the small bone at the base of the thumb. This operation is often combined with one of many types of ligament reconstruction to stop the thumb metacarpal bone falling down into the space left over. This is a reliably good option for improving pain, but it may take up to six months before patients are not thinking about their hand every day. It is sometimes the ONLY option, for example if there is bad arthritis of the joint below the CMC (the scaphotrapeziotrapezoid joint or STT joint), or if the quality of the bone has been badly affected by osteopenia or osteoporosis (age related thinning of the bone).
3) Thumb CMC joint replacement (thumb arthroplasty). This is like a small version of the hip replacement. The cup is inserted into the trapezium bone, and the stem into the metacarpal bone. This surgery has a much faster recovery time - with most patients having excellent movement and little pain by two weeks. Mechanical studies suggest now these implants should survive to ten years in 97% of cases. With time the bone that contacts the implant could loosen, and further surgery might be required in the future.
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