Hand surgery for arthritis includes thumb surgery, joint replacement, and joint fusion. Hand surgery can help people with severe arthritis manage pain and regain range of motion.
Hand surgery for arthritis is an option for people who haven’t responded to more conservative treatments. Many treatment options can reduce the discomfort and pain associated with arthritis. Surgery is the most invasive of these options and may require some downtime for recovery.
This article explores the types of hand and thumb surgery, who makes a good candidate, and the pros and cons. You’ll learn about the recovery timeline and the risks to consider before moving forward.
Several types of hand surgery can help reduce painful symptoms and improve your quality of life. These include joint fusion, joint replacement, and carpal tunnel release.
Joint fusion is surgery that joins two bones to form one solid bone. It can treat arthritis that affects the small joints of the fingers. It is also called arthrodesis.
During the surgery, the surgeon removes damaged cartilage and uses metal plates and screws to hold the bones together while they heal into one solid bone.
Success for this procedure is defined as a reduction in painful symptoms. Because this procedure fuses bones, it’s unlikely that you will retain full mobility.
Joint replacement, also called arthroplasty, is best for larger joints in your hands, like your knuckles.
During this procedures, the surgeon replaces a damaged joint with an artificial one made from plastic components.
But the long-term success rate of this procedure is not great. The artificial joint tends to break down over time from the wear and tear of daily use and chronic inflammation.
Carpal tunnel release
Carpal tunnel release is a surgical procedure for treating carpal tunnel syndrome (CTS). Though not directly caused by arthritis, carpal tunnel syndrome is common in people with rheumatoid arthritis. It happens when inflammation in the wrist puts pressure on the median nerve.
During this procedure, the surgeon makes a tiny incision at the base of your palm and cuts through the tissues pressing on your median nerve. This reduces symptoms such as tingling, numbness, and pain in your hand or wrist.
Pros and cons of hand surgery for arthritis
- It can reduce pain and improve joint function.
- It can be done arthroscopically, which reduces recovery time and scarring.
- It can help restore mobility and range of motion.
Several surgical options can help alleviate symptoms of thumb arthritis. These include arthrodesis, ligament reconstruction and tendon interposition (LRTI), and total joint arthroplasty.
Arthrodesis involves fusing two bones to form one solid bone. It may be ideal for younger, active people who do physically demanding jobs or those who already had thumb surgery but haven’t seen much relief from their symptoms.
Ligament reconstruction and tendon interposition (LRTI)
If your thumb joints are severely damaged by arthritis or injury, your doctor may recommend ligament reconstruction and tendon interposition (LRTI).
This procedure removes damaged joint surfaces and creates a cushion of other tissues to replace them. Surgeons can also reposition your tendons to help your joint function with less pain.
It has a 96% success rate but has a lengthy and painful recovery process, including at least a month of wearing a cast.
Total joint arthroplasty
If other treatments have failed to provide relief in your thumb, your doctor may suggest a total joint arthroplasty. This procedure removes and replaces all or part of the affected joint with a graft made from one of your tendons or metal. Surgeons may also use spacers to keep the joint protected.
Metal joint replacements are better for older adults who don’t have a lot of functional demand. Spacers are better for younger and more active adults with advanced arthritis.
Hematoma and distraction arthroplasty
If you are older or have a failed reconstruction procedure, your doctor may recommend a hematoma and distraction arthroplasty.
This involves removing the trapezium bone in the wrist and immobilizing the thumb with a wire for 6 weeks.
It is a less invasive operation than traditional arthroplasty. A
Your doctor may recommend surgery if the arthritis progresses to a point where medications and other treatments are no longer effective.
This could be because of severe joint damage, pain not responding to other treatments, or when mature age and low activity level make it more likely for you to benefit from surgery.
The first step is finding a qualified hand surgeon to assess your condition. Your primary care physician can provide referrals, or you can search for board certified surgeons in your area.
When you meet with the surgeon, they will likely ask questions about your medical history and perform a physical exam. You should also come with relevant medical records, such as ultrasounds, X-rays, or MRI scans.
The surgeon will explain the surgeries and their potential risks and benefits during the consultation. Depending on your condition, they may recommend one or more procedures.
You may also want to:
- ask questions to understand how proficient the surgeon and hospital are in that procedure
- discuss lifestyle and dietary changes you may need to make before and after surgery
- get advice on whether you need to do any checkups, such as dental, before the procedure
- ask about the surgical facility and whether you’d prefer to be in an outpatient clinic or a hospital setting
These questions can help you make the right decision and prepare you for the best outcome and recovery.
Risks and complications of hand surgery for arthritis include:
- nerve injury, which you may feel as numbness
- reduced joint movement and mobility in your hand, wrist, or thumb
The risks may differ depending on the procedure and the extent of damage you have.
Hand surgery may be a good option if your arthritis has not improved with less invasive treatments. It may reduce your pain and improve the mobility of your fingers and thumbs. But hand surgery has risks like infection and scarring. Discuss your options with a surgeon.