You don't have to deal with thumb pain forever...

hand pain

Basal thumb arthritis, often referred to as CMC joint arthritis or simply thumb joint arthritis, can be very disabling, causing severe hand pain and swelling, as well as decreased strength and range of motion. A painful, arthritic thumb may make it difficult to complete many daily household tasks such as turning a doorknob or opening a jar.

Luckily there are solutions out there for you. Many treatment options exist for thumb joint arthritis. The following page discusses some common options as well as an alternative treatment option, known as implant arthroplasty. The BioPro Modular Thumb Implant is a device that is implanted in the base of your thumb, allowing patients suffering from thumb pain to regain range of motion while providing a firm foundation for grip strength and pain relief.

What is thumb arthritis?

Base of thumb arthritis, eps8

Normally in a joint, cartilage covers the ends of bones and creates a shock absorber to allow pain-free movement. With arthritis, the cartilage deteriorates, which results in contact between the bones. This produces pain and eventually deformity. We are discussing arthritis of the base of the thumb. This is the most common site of arthritis in the hand. The joint, also called the carpometacarpal or CMC joint, is a saddle shaped joint that allows the thumb to have a wide range of motions. This gives you the ability to pinch and grab things. CMC joint arthritis may make it difficult to accomplish many everyday tasks.

Who gets it?

Arthritis of the base of the thumb is more commonly seen in women over the age of 40. It is a fairly common problem that happens to around 7% of men and 15% of women. There are conservative treatments, but many arthritic thumb cases commonly requires surgery.

What are the symptoms?

The most common symptom of CMC joint arthritis is pain at the base of the thumb. It often becomes difficult to do everyday tasks, such as opening jars, turning door knobs or writing. The pain can become so severe that you may experience pain at night when sleeping. In more severe cases destruction and mal-alignment of the joint occurs, and a bump develops. If you start to experience these symptoms you may want to consult your doctor, who can advise you on the best option to treat your discomfort. They will diagnose you by a physical evaluation as well as X-rays of your hand. X-rays are used to confirm the diagnosis, although the severity of your arthritis cannot always be determined with x-ray findings.

Treatment Options

Conservative Treatment Options – What Happens First

Once diagnosed with thumb arthritis, your doctor may offer you many different treatment options. They will most likely start with conservative treatments such as anti-inflammatories or cortisone injections. These treatments may alleviate your symptoms and help reduce pain for a short period of time, however in most instances they will not completely resolve the problem. If these treatments do not help your pain your doctor may refer you to a surgeon to discuss your discomfort.

Surgical Treatment Options

Once conservative treatment is no longer effective , your doctor may recommend surgery. Below are the most common surgical procedures used to treat CMC arthritis.

Trapezial Resection with Ligament Reconstruction

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 cuts 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 six weeks and mobility after surgery will be limited. The cosmetics of your hand also may be altered. Should this procedure fail, there are not many good treatment options remaining. The only real revision option is to harvest another tendon and try the procedure again

Fusion

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. You will completely lose mobility 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.

Implant Arthroplasty

A portion of the bone in the base of the thumb metacarpal is removed and the implant is placed in the space from the damaged joint. A new socket that provides a smooth surface for the implant to move in is formed. Your hand is then placed in a cast which keeps the thumb joint in a specific position while your healing begins. You will be in a cast for 4-6 weeks, depending on your healing. The treatment we are discussing is called an Interpositional Arthroplasty. 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.

The BioPro Modular Implant Option

The BioPro® Modular Thumb Implant provides relief for arthritis in the metacarpal-trapezium joint. The implant, which is made in Michigan U.S.A, comes in four stem sizes and 12 head sizes for a customized fit. It has plasma spray on the stem for bone in-growth. This procedure has the advantage of maintaining movement and a firm foundation for pinch and grip strength. It also minimizes frequent complications of other procedures, such as dislocations, material failure, and complicated invasive soft tissue reconstructions.

The Implant’s History

The BioPro® Thumb Implant has been used successfully for over 17 years. Originally manufactured as a one piece implant, it was designed in 1996 by Charles Townley, MD, the founder of BioPro. In the early 2000′s the original one piece design was evaluated and, with the help of Dr Louis Habryl, the Modular Implant was created in 2004. In addition to the implant, simple instrumentation was developed, making the procedure easily reproducible. There are other thumb implants available on the market, but none have the long term, peer reviewed clinical data supporting their use like the BioPro® Modular Thumb Implant.

Clinically Proven

A recent study, published in May 2012 in Clinical Orthopedics and Related Research, featured the use of the BioPro®Modular Thumb Implant for treatment of trapeziometacarpal osteoarthritis. The study included 159 basal joint hemiarthroplasties to treat osteoarthritis of the trapeziometacarpal joint. Of that, 143 thumbs were available for review. Pain relief occurred in 135 thumbs, function improved in 138 thumbs, 139 thumbs were excellent or good in overall assessment, and 142 thumbs had good or excellent cosmetic appearance. The mean postoperative Buck-Gramcko Score was 49(excellent) and the implant showed a 94% survivorship at a mean follow up of 72.1 months. If you would like to view the full study us our contact form to request a copy.

What Happens During And After Surgery

The bone in the base of the thumb is removed and the implant replaces the damaged joint. A new socket that provides a smooth surface for the implant to move in is formed. Your hand is then placed in a cast that keeps the thumb joint in a specific position while your healing begins. You will be in a cast for 4—6 weeks, depending on your healing. After your cast is removed, you may have hand therapy to regain your strength and motion. Most patients have unrestricted activity 8—12 weeks after surgery. The BioPro® Modular Thumb implant is intended to treat localized basal thumb (CMC or carpometacarpal) joint arthritis. The Modular Thumb implant is not recommended for patients who in addition to basal thumb arthritis, have arthritis in adjacent joints, such as the trapezium/scaphoid joint. If considering the BioPro® Modular Thumb implant consult your doctor today to see if this treatment is right for you.

In some rare cases you may experience some minor discomfort for several months after surgery while the bone remolds and the hand adjusts to the implant. If you experience this pain you should consult your physician to ensure that the pain is not a more serious issue.

F.A.Q's

Most patients with localized basal thumb joint arthritis are candidates for the BioPro Modular Thumb Implant, but only your surgeon can make the final determination. If your arthritis has spread to adjacent joints in the hand, you would not be a candidate for the implant.
Yes, most insurance plans cover this procedure. It is important to get a pre-authorization from your insurance company prior to surgery.

• This procedure has the advantage of maintaining movement and a firm foundation for pinch and grip strength.
• Thumb mobility is almost normal and appearance of the hand remains normal.
• It minimizes frequent complications of other procedures such as dislocations, material failure, and complicated invasive soft tissue reconstructions.

Every surgery is unique, however published clinical study shows the success rate of the BioPro Modular Thumb Implant at 94%. If you would like a copy of that study, contact us today.
You will be immobilized for 4-6 weeks, depending on your healing. After that, you may have therapy to regain your strength and motion. Most patients have unrestricted activity 8-12 weeks after surgery. A small portion of patients may have some residual pain for up to a year after the procedure as your body adapts to the implant.
There are many surgeons located around the U.S that currently use the BioPro Modular Thumb Implant. If you would like contact information on surgeons near you, fill out the contact form to the right and one of our customer service agents will be happy to give you the information.
Surgeons in different areas of the country are often exposed to different methods in training and become comfortable with specific procedures they utilize, especially if they are getting good results and their patients are happy. It is possible they are just unaware of the implant, or they just may not be ready to switch from their current preferred procedure.