A Complete Guide to Thumb Arthritis Surgeries: Your Treatment Options

Thumb arthritis, particularly at the base of the thumb (in the carpometacarpal or CMC joint), is a common condition that can significantly affect your quality of life. The CMC joint is essential for the thumb’s mobility, and when it wears down due to arthritis, tasks like gripping, pinching, and opening containers can become painful and difficult.

For many people with advanced thumb arthritis, conservative treatments such as medication, splinting, and physical therapy no longer provide adequate relief. In these cases, surgery may be the next step. There are two primary categories of surgery: those that remove the trapezium bone (located at the base of the thumb) and those that replace the joint with an implant.

The type of surgery you undergo will depend on the severity of your arthritis and your surgeon’s preferred method. In Europe, joint replacement implants are commonly used, while in the U.S., many surgeons still prefer a procedure called trapeziectomy, which involves removing the trapezium bone. Recently, the BioPro Modular Thumb Implant is gaining popularity in North America as a reliable alternative for treating thumb arthritis.

Joint Replacement Surgery

Joint replacement surgery aims to replace the damaged cartilage and bone in the CMC joint with an implant. Unlike the trapeziectomy procedure, which removes the trapezium bone, joint replacement uses a durable metal implant to replace the joint—similarly to how hip replacements work.

BioPro Modular Thumb Implant

The BioPro Modular Thumb Implant is a two-piece metal implant (made from cobalt chrome or titanium) designed specifically for the CMC joint of the thumb. This implant is often recommended for patients who need to maintain strength and functionality and desire a quicker recovery.

How It Works: During the procedure, the surgeon makes a small incision at the base of the thumb and removes the damaged cartilage from both sides of the joint. The surgeon will create a small socket in the trapezium bone where the implant head will fit, and the stem of the implant will be placed into the metacarpal bone. The BioPro Modular Thumb Implant is unique because it allows surgeons to customize the implant size during surgery, offering 48 different options to best match your anatomy.

Benefits:

• Restores Function: The implant allows for natural thumb movement, helping you regain the ability to grip, pinch, and perform other everyday tasks.
• Long-Lasting Results: The BioPro Implant is made from durable materials, designed to last for many years. While the life span of the implant is still being studied, some patients currently are 20+ years post-op.
• Pain Relief: By replacing the damaged cartilage and bone, joint replacement surgery provides significant relief from pain.
• Preserves Thumb Length: Since the trapezium bone remains in place, the implant helps maintain the cosmetic appearance of the thumb.
• Quick Recovery: Many patients experience pain relief and restored function within weeks.
• Future Flexibility: If the implant doesn’t provide the desired results, it can be removed, and a traditional procedure can be performed.

Limitations:

• Post-Surgery Discomfort: Some patients may experience discomfort while the trapezium bone remodels to accommodate the implant, although this usually resolves within a year. This can often be managed with NSAID’s, activity modification, and immobilization.
• Potential Metal Sensitivity: Like all implants, there’s a small risk of an allergic reaction to the metal. BioPro offers both cobalt chrome and titanium options, so it’s essential to discuss any concerns with your surgeon.
• Scapho-Trapezium Arthritis: The BioPro implant only treats the arthritic CMC (thumb) joint.  If left untreated, arthritis can begin to affect the adjacent joint, the ST joint (scapho-trapezium).  This is a contra-indication for the use of the implant.

Ideal Candidates: This procedure is ideal for individuals who need to maintain strength and dexterity, such as musicians, artists, or people with physically demanding jobs.

Trapezium Bone Removal Procedures

Trapezium bone removal surgeries, also called trapeziectomy, involve removing part or all of the trapezium bone. These procedures have been the standard treatment for thumb arthritis for decades and are generally effective at providing pain relief and restoring function over time.

Common Types of Trapeziectomy Procedures:

• LRTI (Ligament Reconstruction and Tendon Interposition): This procedure involves using a tendon from your forearm to stabilize the joint after the trapezium bone is removed.
• Suspensionplasty (Suture Suspension): This technique uses a suture implant to suspend the metacarpal without needing to harvest a tendon.

How It Works: During the surgery, the surgeon makes a small incision at the base of the thumb and removes the trapezium bone. If performing an LRTI, a tendon is harvested from the forearm and placed into the joint space to stabilize the metacarpal. With suspensionplasty, sutures are used to achieve the same goal without tendon harvesting.

Benefits:

• Effective Pain Relief: Removing the trapezium bone eliminates bone-on-bone contact, resulting in reliable pain relief.
• Restores Function: Most patients regain good thumb mobility and function after the procedure.
• Low Risk: Trapeziectomy is a well-established surgery with a relatively low complication rate.

Limitations:

• Reduced Strength: Although the surgery alleviates pain, it may result in a slight decrease in grip strength.
• Instability Risk: Removing the trapezium can affect thumb stability, leading to a potential loss of functional ability over time.
• Thumb Shortening: Over time, the thumb may shorten slightly as the metacarpal moves down into the joint space.
• Limited Revision Options: Once the trapezium is removed, reversing the procedure or performing a joint replacement can be difficult.

Ideal Candidates: Trapeziectomy is best for patients who prioritize pain relief over strength and function or for those with severe arthritis affecting multiple joints.

Choosing the Right Surgery for You

Deciding between joint replacement and trapezium bone removal largely depends on your arthritis severity, your activity level, and your goals for thumb function. Here’s a quick breakdown of which option might be best for you:

• Joint Replacement (BioPro Modular Thumb Implant): Ideal for individuals who want to maintain normal thumb strength and function.
• Trapezium Bone Removal (Trapeziectomy, LRTI, Suspensionplasty): Best for patients focused primarily on pain relief, especially when arthritis is severe.

Consulting with a skilled hand surgeon is crucial to finding the best approach for your condition. Your surgeon can assess your situation and recommend the surgery that will provide the best balance of pain relief and functional recovery.