Surgery to replace your thumb joint could involve a tendon transfer or an artificial replacement. There are also newer techniques that use a wire or suture as a sling to support your thumb.
As people age, the thumb joint becomes a common site of arthritis. The ligaments that hold the joint together can also loosen, causing it to slip. Or, the cartilage pad between the wrist joint (trapezium) and the joint at the base of the thumb (first carpometacarpal) can wear out.
This can cause stiffness, pain, and disability that a doctor can correct with carpometacarpal (CMC) arthroplasty, otherwise known as total thumb joint replacement.
To perform this surgery, a surgeon can use either a ligament from your body to cushion the joint or insert metal, silicone, or plastic prostheses. If they use a ligament, the procedure is known as ligament reconstruction and tendon interposition (LRTI). If they use a prosthesis, it’s called a total joint replacement.
A doctor may also recommend variations of these techniques. This article reviews and compares various options for CMC arthroplasty.
During LRTI, a surgeon removes the damaged bone surfaces and part or all of the trapezium bone in your wrist. They then use your ligament to make a cushion to separate the remaining bones.
Doctors have performed this surgery for decades, often improving symptoms and thumb function. Still, there are downsides:
- It can take a long time to recover.
- Your thumb may be noticeably shorter.
- Your thumb might not be as strong or work as well as before it was damaged.
- The benefits may eventually wear off as pain and malfunction return.
Total joint arthroplasty (aka total joint replacement) involves removing the damaged bone surfaces and replacing them with a prosthesis. This artificial replacement is made of either pyrocarbon or metal. They also use synthetic spacers to sit between the bones.
If you are younger and very active, with a lot of demand on the joint, a doctor may recommend synthetic spacers because metal prostheses can fail with heavy use.
Most CMC arthroplasties are successful and complication-free. Some conditions can increase your risk of complications, including diabetes and undergoing renal dialysis. But a
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Removing the trapezium does come with additional risks, such as a loss of pinch strength and a potentially shortened thumb.
This technique is less invasive and has a shorter operating and recovery time. A
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What works best for you will depend on the following:
- your age
- the amount of demand on your thumb joint
- the amount of damage to your thumb joint
- any preexisting conditions or injury
You’ll also need to consider whether your desired outcome is a realistic result of the specific procedure.
After surgery, joint replacement may give you better function and a more natural-looking thumb. But it is more expensive and more likely to create complications. The prosthesis is more likely to fail if you use your thumb joint often.
The following table offers a comparison between LRTI and total joint replacement:
| LRTI | Total CMC Joint Replacement |
|---|---|
| For less damaged joints | For more damaged joints |
| Less expensive | More expensive |
| Fewer complications | May have more complications |
| Less restored range of motion | Better restored range of motion |
| More noticeable differences in appearance | More regular appearance |
HDA and SSA are simpler surgeries that may offer similar results. But there’s less research available to support their effectiveness.
Talk with a specialized hand surgeon about which option may be best for you.