Learn about five surgical procedures used to treat joint damage and pain caused by basal thumb arthritis.
During a fusion, the two arthritic bones are attached together via a screw or plate. The bones will then grow together, eliminating painful bone-on-bone contact, but also eliminating any motion at that joint. Fusion is frequently unacceptable to many patients because of the loss of movement in the joint. Additionally, fusion often leads to arthritis in adjacent joints as these joints become over used once the thumb joint is fused. After a fusion is completed you will be immobilized for 6 to 8 weeks. Your mobility will be reduced and the cosmetics of your hand may also be altered. If a fusion fails, revision options include trapezial resection with ligament reconstruction as well as implant arthroplasty.
Ligament Reconstruction with Tendon Interposition (LRTI)
Trapezial resection with ligament reconstruction goes by a number of different names, Anchovy, LRTI or TMIA. This procedure involves full or partial removal of the arthritic bone at the base of the CMC joint (the trapezium). A series of small incisions are made in the forearm to split a tendon, which is moved to the base of the thumb to fill in the area from which the trapezium bone was removed. The thumb now rests on a soft tendon pillow, not a hard piece of arthritic bone (which is painful). Immobilization for a LRTI’s is typically six weeks and mobility after surgery may be limited. The cosmetics of your hand also may be altered. Should this procedure fail, revision options are typically limited to repeating the procedure with another tendon.
Removing the trapezium may shorten the thumb and leave patients few other options if symptoms persist,” Dr. Badia states. He adds that recovery from this kind of surgery also can be prolonged and painful.
The concept of arthroscopy may be most beneficial in the early stages of basal joint arthritis. The earliest presentation of this painful condition has few surgical options once conservative treatment has been exhausted. The patient who continues to have pain, despite several cortisone injections and prolonged splinting, may agree to an arthroscopic procedure. This is because a minimally invasive procedure at this small joint presents the same advantages that it does in larger, but more accepted, procedures, such as knee arthroscopy. An arthroscopic evaluation of this joint gives us the true stage of arthritis and minimizes the importance of radiographic staging. In fact, an arthroscopic classification has been suggested, and may well lead to the treatment options. During arthroscopy, your surgeon may remove bone spurs, perform an osteotomy to realign the joint, or recommend transitioning to another form of surgical correction.
Arthroscopic assessment of the first carpometacarpal joint allows easy identification and classification of joint pathology with minimal morbidity.
Joint Replacement (Arthroplasty)
A portion of the bone at the base of the thumb metacarpal is removed and a socket is formed in the trapezium. An implant is then placed in this space, replacing the damaged joint. Your hand is then placed in a cast which keeps the thumb joint in a specific position while your healing begins. This procedure has the advantage of maintaining movement and a firm foundation for pinch and grip strength. If implant arthroplasty fails, revision options include trapezial resection with ligament reconstruction as well as fusion.
Learn more about the BioPro Modular Thumb Implant here.
Main advantage of joint replacement surgery is that no bridges have been burned,” Dr. Badia adds. “If a patient’s symptoms persist, the thumb implant can be readily removed, and another surgical procedure performed.”
A wedge is cut out of the metacarpal to repositon the joint, transfering forces to help allievate pain and return normal function.