Thumb arthritis surgery is an option when arthritis is causing debilitating pain and stiffness that doesn’t respond to alternative treatments.

Thumb arthritis is a painful condition of joint inflammation typically affecting the basal joint at the base of the thumb, also known as the “carpometacarpal (CMC) joint.”

Its most common cause is osteoarthritis, a type of arthritis that can cause bone-on-bone friction and lead to total joint deterioration.

While there are a number of nonsurgical treatments available to manage thumb arthritis (sometimes called “basal thumb arthritis”), surgery is an option when traditional approaches aren’t helping.

There’s no singular thumb arthritis surgery that works for everyone. When a doctor recommends surgery, a handful of options are available based on your specific needs.

Ligament reconstruction

This procedure involves stabilizing your thumb joint using a piece of the flexor tendon from your wrist. It’s used when thumb arthritis is caused by looseness in the joint but not cartilage loss.

While ligament reconstruction may help preserve the thumb joint for some time, it doesn’t repair or stop tissue damage.

Ligament reconstruction and tendon interposition (LRTI)

This surgery type is the most regularly performed for thumb arthritis surgery. LRTI involves removing the damaged tissues of the joint and replacing them with a cushion made from your flexor carpi radialis (FCR) tendon or an artificial insert.

LRTI includes the partial or complete removal of your trapezium bone to help create space and reduce bone friction.

Trapeziectomy

When tendons aren’t rearranged, and only the trapezium bone is removed, the procedure is known as a “trapeziectomy.”

A systematic review and research of more than 8 studies and 600 people found no statistical difference in the outcomes between LRTI and simple trapeziectomy.

The research also noted LRTI had more short-term postoperative risks, higher surgical costs, and more procedure-related injuries.

Hematoma and distraction arthroplasty

Hematoma and distraction arthroplasty is a controversial procedure because of the limited evidence to support its use.

The procedure involves a trapeziectomy and the placement of a wire to immobilize your thumb in an overcorrected position. The goal is to encourage scar tissue in a specific location to create an artificial joint.

Total joint replacement (arthroplasty)

When thumb arthritis has severely affected your CMC, it’s possible to completely replace the joint with a prosthetic.

Arthroplasty isn’t a first-line option, as arthroplasty may not be as durable as tendon grafts for long-term use.

A review from 2019 shows that different implants have varying rates of failure, but overall failure rates of nonimplant techniques are better than those of arthroplasty.

Arthrodesis

Arthrodesis is the process of fusing bones. A surgeon fits the bones in your thumb joint inside one another and locks them in place with a metal pin. In time, new bone growth should fuse the pieces together.

Research indicates arthrodesis is traditionally used in younger people with osteoarthritis because it can offer better stability and strength compared with other thumb arthritis surgeries.

Arthrodesis isn’t an option for everyone. The procedure is complex and comes with a risk that the bones won’t fully fuse together, resulting in the need for multiple follow-up surgeries.

The average cost for thumb surgery may range from $3,000 to upward of $7,000.

A cost analysis review in 2021 found U.S. national averages for LRTI and hematoma and distraction arthroscopy spanned from $4,300 to $5,200, depending on which region of the country in which the surgery was performed.

Medicare lists the average cost for LRTI as around $3,700, but that price only includes the facility and doctor fees.

A 2021 study found the cost of arthroscopy to be one of the most expensive options, costing between $6,100 and $7,200.

Insurance coverage

As a clinically necessary reconstructive surgery, most private insurance carriers will cover thumb arthritis surgery. How much coverage costs will depend on the insurance plan. If you’re enrolled in Medicare, up to 80% of thumb arthritis surgery may be covered.

The 2021 study indicates you’ll likely pay more out-of-pocket fees under private insurance versus Medicare.

Non-Medicare enrollees paid up to $952 out of pocket compared with up to $332 for Medicare participants.

Overall, the majority of thumb arthritis surgeries have positive outcomes. Success rates vary between 96% for LRTI and 89% for total joint replacement.

When it comes to postoperative follow-up procedures and risks, large-scale national data shows simple trapeziectomy has the lowest rates compared with arthroplasty and fusion with the highest rates.

No matter which thumb arthritis surgery you have, your hand needs time to recover. The surgeon will give you detailed instructions to follow for your safety and recovery.

Immediately after surgery, instructions usually involve taking care to keep your hand elevated whenever possible to help limit swelling. The focus may be on managing pain and keeping the injured area safe.

Recovery times will vary based on the procedure and may take up to 6 weeks. You may have a cast, bandage, or splint. It’s normal to need different types of bandaging throughout the stages of recovery.

Once you’ve healed enough, a rehabilitation specialist will help you build strength and regain function in your hand.

A doctor and surgeon can answer any questions you might have in addition to the following:

Is thumb surgery painful?

Thumb surgery, and any surgery, can be painful. Thumb arthritis itself is characterized by discomfort, but you may find the pain of surgery is less than the everyday arthritis pain with which you’ve been living.

Also keep in mind that while the first postoperative days can be uncomfortable, this pain will rapidly decrease as the swelling and inflammation improve. Ultimately the goal is to leave you with less pain than you had.

Are you awake during thumb surgery?

Some thumb surgeries, such as trapeziectomy, can be performed using local anesthetic, which numbs the hand while you’re awake.

More invasive surgeries, such as total joint replacement, are done under full or general anesthesia.

How soon can you drive after thumb surgery?

The surgeon will make a driving recommendation based on your procedure and recovery.

You may need to wait the full 6 weeks, or a doctor may let you drive as soon as you can be in full control of the car without compromising your surgical site.

How should you sleep after thumb surgery?

Keeping your hand elevated can be important right after surgery, even when sleeping. This doesn’t mean your hand has to be above your head, but you may want to keep it higher than your heart.

A pile of pillows can usually do the trick.

There are many different options for thumb arthritis surgery: from minor ligament reconstruction to total joint replacement.

The procedure a doctor recommends will depend on your level of pain, existing thumb function, and stage of joint deterioration.

Recovery can take up to 6 weeks, but the majority of people experience improvements in pain level and thumb function after the operation.