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Arthritic thumb is the wear and tear of the thumb cartilage that leads to disabling pain. If several treatments are insufficient and if the condition worsens until thumb deformity, it is necessary to consider more radical solutions.
Do I need surgery for arthritic thumb?
Surgery as first line approach of treatment is only performed in case of trapeziometacarpal joint malformation likely to cause a biomechanical dysfunction of the thumb. It can also be necessary if a significant laxity causes early rhizarthrosis. Apart from these cases, less invasive treatments are always favoured.
If all the treatments for arthritic thumb have proved to be ineffective, it is very likely that your doctor suggests you a surgery.
Different surgical techniques for arthritic thumb
Depending on cases, several surgical techniques are possible: arthrodesis, trapeziectomy and prosthesis(1).
Arthrodesis consists in the fusion of the first metacarpal bone and the trapezium to immobilise the joint and reduce 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 surgical technique: removal of the trapezium or prosthesis. If rhizarthrosis 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, trapeziectomy (removal of the trapezium bone) is appropriate. If rhizarthrosis only affects the trapeziometacarpal joint, several criteria like age, degree of the deformity and mobility determine the best surgical technique.
The advantage of trapeziectomy is its safety. This surgical procedure 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. Often used in patients under 70 years old, trapeziectomy allows to keep optimal function of the hands.
In severe cases, the trapeziometacarpal joint can be 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 prosthesis, without involvement of the junction between the two first metacarpals. This technique 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.
In order to limit the progression of arthritic thumb and to delay surgery as much as possible, wearing braces that immobilise the thumb is highly recommended. Therefore, your joint is less used and pain decreases. EPITACT® suggests you two braces for arthritic thumb: a brace to wear during the day* and a brace for night*.
*These products 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.