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Arthritic thumb is the wear and tear of the thumb cartilage that leads to disabling and chronic pain. Whether medical treatments are insufficient or the condition worsens until thumb deformity, it is necessary to consider more radical solutions like basal thumb arthritis surgery.
Discover the main techniques: trapeziectomy surgery, thumb basal joint arthroplasty and arthrodesis(1).
Focus on the main surgical procedures for basal thumb arthritis surgery: trapeziectomy surgery, arthroplasty and arthrodesis
Among all the techniques available for basal thumb arthritis surgery, trapeziectomy is the most frequent one. No matter which technique is used, all of them are intended to relieve pain permanently.
Arthrodesis of the thumb: fusion of the thumb joint
Arthrodesis of the thumb consists in the fusion of the thumb joint, precisely of the first metacarpal bone and the trapezium. This procedure immobilises the joint and reduces the pain. As a consequence, the motion of the thumb is definitively limited. This technique is less frequent than the two other ones.
X-ray is used to choose the correct technique for basal thumb arthritis surgery: trapezium bone removal or prosthetics. If thumb arthritis not only affects the trapeziometacarpal joint, a prosthesis is not appropriate.
Indeed, if the surrounding joints are also damaged, replacing only one joint won’t save the others. In this case, the trapeziectomy surgery is appropriate. If thumb arthritis only affects the trapeziometacarpal joint, several criteria like age, degree of the deformity and mobility determine the best surgical option.
Trapeziectomy surgery: trapezium bone removal
The advantage of trapeziectomy is its safety. This technique for basal thumb arthritis surgery has less infectious risks and preserves partial mobility of the thumb. However, it doesn’t correct the deformity. It entails a loss of strength of the thumb-index pinch and a modification of the thumb biomechanics. The trapeziectomy surgery is often performed in patients under 70 years old and allows to keep optimal function of the hands.
Thumb basal joint arthroplasty surgery, prosthetic thumb: thumb joint replacement
In severe cases, the surgeon chooses the thumb joint replacement surgery: all or part of the damaged joint is removed and replaced by a prosthesis(2), often screw-retained. This technique is only employed if the trapeziometacarpal joint is the only joint affected.
Another criterion is that the trapezium and metacarpal are to be in good condition to receive the implant, without involvement of the junction between the two first metacarpals. The thumb basal joint arthroplasty surgery is used in patients over 70 years old who are unlikely to apply excessive strain on the prosthesis. Indeed, one of the main complication risks is the dislocation or aseptic loosening of the prosthesis.
When to have thumb arthritis surgery?
Basal thumb arthritis surgery as a first line approach of treatment is only performed in case of malformation of the trapeziometacarpal joint that is likely to cause biomechanical dysfunction of the thumb. It can also be necessary if significant laxity causes early thumb arthritis.
Apart from these cases, less invasive treatments are always considered first. Then, if all the medical treatments have been ineffective, your doctor may suggest surgery.
In order to limit the progression of basal thumb arthritis and delay surgery, you can wear arthritic thumb support braces. The EPITACT® rigid thumb braces for arthritis* immobilises your thumb in a neutral position and reduces your pain at night and rest. The EPITACT® flexible arthritic thumb support* for activities helps your thumb to return in a resting position but preserves range of motion. Both limit microtraumas to the joint by keeping the thumb aligned with the first metacarpal and bones in the wrist.
To sum up, basal thumb arthritis surgery is required for advanced cases. According to several criteria (stage, affected area, age…), the hand surgeon can choose different techniques: trapeziectomy surgery, basal thumb joint arthroplasty surgery or arthrodesis of the thumb. For more information about the condition, read the following articles on the treatments and ways to fight against thumb arthritis.
*These solutions are class I medical devices that bear the CE marking under this regulation. Carefully read the instructions before use. Manufacturer: Millet Innovation. 06/2020
For more details about this general and simplified approach, here are further sources:
(1)Vermeulen GM, Slijper H, Feitz R, et al. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg 2011;36:157–69. 05/2012 (3)De la Caffiniere JY. Longevity factors in total trapezometacarpal prostheses. Chir Main 2001;20:63–7.
(2)De la Caffiniere JY. Longevity factors in total trapezometacarpal prostheses. Chir Main 2001;20:63–7.