Thumb Arthritis Surgery: Treatment Options & Recovery Guide

What Is Thumb Arthritis and Why Is Surgery Needed?

Thumb arthritis, or CMC (carpometacarpal) joint osteoarthritis, occurs when the cartilage at the base of the thumb wears away, causing painful bone-on-bone contact. Surgery becomes necessary when conservative treatments no longer provide adequate pain relief and the condition significantly impacts daily activities and quality of life.

The thumb is uniquely important among our fingers because it enables the pinch and grip functions that are essential for nearly every hand activity. The carpometacarpal (CMC) joint at the thumb base is a highly mobile saddle joint that allows the thumb to move in multiple directions, making it particularly susceptible to wear and tear over time. This joint experiences significant forces during everyday activities - forces that can be 10-15 times greater than the weight being lifted or the pressure being applied.

Thumb base arthritis, also known as basal joint arthritis or trapeziometacarpal arthritis, is one of the most common forms of osteoarthritis in the hand. The condition primarily affects the joint between the trapezium bone (a small bone in the wrist) and the first metacarpal bone (the bone that connects to the thumb). When the protective cartilage in this joint deteriorates, the bones begin rubbing against each other, causing pain, stiffness, weakness, and loss of function.

The condition is significantly more prevalent in women than men, with studies showing a female-to-male ratio of approximately 10-15:1. This gender disparity is thought to be related to hormonal factors, joint laxity, and anatomical differences. The risk increases substantially after age 50, and radiographic evidence of thumb CMC arthritis is present in up to 25% of women and 8% of men over 55 years of age.

Stages of Thumb Arthritis (Eaton Classification)

The severity of thumb arthritis is commonly classified using the Eaton staging system, which helps guide treatment decisions. Understanding your stage can help you and your surgeon determine the most appropriate treatment approach.

Surgery is typically considered when patients have Stage III or IV arthritis and conservative treatments have failed to provide adequate relief. However, the decision to proceed with surgery is based on the patient's symptoms and functional limitations rather than X-ray findings alone. Some patients with significant radiographic changes may manage well with conservative treatment, while others with moderate changes may benefit from earlier surgical intervention.

What Are the Different Types of Thumb Arthritis Surgery?

The main surgical options for thumb arthritis include trapeziectomy (removal of the trapezium bone), LRTI (ligament reconstruction and tendon interposition), joint replacement (arthroplasty), and joint fusion (arthrodesis). Trapeziectomy with or without LRTI is the most commonly performed and has the longest track record of success.

Several surgical techniques are available for treating thumb CMC arthritis, and the choice depends on factors including the patient's age, activity level, stage of arthritis, and surgeon experience. Each procedure has its own advantages and considerations, and your hand surgeon will recommend the most appropriate option based on your individual circumstances.

Trapeziectomy (Simple Trapezium Excision)

Trapeziectomy involves the complete removal of the trapezium bone, eliminating the arthritic surface entirely. This procedure has been performed since the 1940s and remains one of the most reliable surgical treatments for thumb base arthritis. The space left after removing the bone fills with scar tissue over time, which acts as a cushion between the remaining bones.

The main advantage of simple trapeziectomy is its relative simplicity and shorter operative time. Studies have shown that outcomes are comparable to more complex procedures, and the surgery avoids potential complications associated with tendon harvesting or implant use. Recovery involves wearing a splint for 4-6 weeks followed by graduated hand therapy.

LRTI (Ligament Reconstruction Tendon Interposition)

The LRTI procedure combines trapeziectomy with reconstruction using a tendon harvested from the patient's forearm (typically the flexor carpi radialis or palmaris longus tendon). The tendon is used to reconstruct the ligaments that stabilize the thumb and to fill the space left by the removed trapezium, acting as a biological spacer.

Proponents of LRTI argue that the tendon interposition provides better thumb stability and prevents the metacarpal from migrating proximally (toward the wrist). However, numerous studies, including Cochrane systematic reviews, have found no significant long-term difference in outcomes between simple trapeziectomy and LRTI. The LRTI procedure does add operative time and creates an additional surgical site for tendon harvesting.

Joint Replacement (Arthroplasty)

Joint replacement involves removing the arthritic surfaces and replacing them with artificial components, similar to hip or knee replacement. Various implant designs have been developed over the years, including silicone, pyrocarbon, and metal-on-polyethylene prostheses.

While joint replacement theoretically preserves thumb length and motion better than trapeziectomy, implants have historically had higher complication rates including loosening, dislocation, and failure requiring revision surgery. Newer implant designs show promise, but long-term data is still limited compared to trapeziectomy. Joint replacement may be considered for younger, active patients who wish to preserve thumb length, but the potential need for future revision surgery must be discussed.

Arthrodesis (Joint Fusion)

Arthrodesis permanently fuses the CMC joint, eliminating motion at that joint but providing excellent stability and pain relief. This procedure may be preferred for younger, very active patients, heavy laborers, or those who require maximum thumb stability for their work or activities.

The disadvantage of fusion is the complete loss of motion at the CMC joint, although compensatory motion at other thumb joints partially preserves overall thumb function. Fusion also creates stress concentration at adjacent joints, potentially accelerating arthritis development at those levels over time.

How Should I Prepare for Thumb Arthritis Surgery?

Preparation for thumb arthritis surgery includes a pre-operative assessment with your surgeon, medical clearance if needed, understanding anesthesia options, and planning for post-operative needs such as help at home and time off work. Most patients can eat and drink normally until the night before surgery.

Proper preparation can help ensure the best possible outcome from your surgery. Your surgical team will provide specific instructions, but understanding the general process can help reduce anxiety and ensure you're ready for both the procedure and recovery.

Pre-operative Assessment

Before surgery, you'll meet with your hand surgeon to discuss the procedure in detail, review your medical history, and undergo a physical examination. X-rays and possibly other imaging studies will be reviewed to plan the surgical approach. This is an excellent opportunity to ask questions and discuss your expectations and concerns.

If you have other medical conditions such as heart disease, diabetes, or take blood thinners, you may need clearance from your primary care physician or specialists. Your surgeon will provide guidance on which medications to continue or stop before surgery. Common instructions include stopping blood thinners (aspirin, warfarin, etc.) several days before surgery as directed, and continuing most other regular medications.

Anesthesia Options

Thumb arthritis surgery can be performed under several types of anesthesia. The most common options include:

• Regional anesthesia (nerve block): Local anesthetic is injected near the nerves supplying the arm, numbing the entire hand and forearm. This is often combined with mild sedation for comfort. Regional anesthesia provides excellent pain control during and immediately after surgery.
• General anesthesia: You are completely asleep during the procedure. This may be preferred for anxious patients or those who don't want to be aware during surgery.
• Local anesthesia with sedation: The surgical area is numbed, and you receive medication to help you relax. You remain conscious but comfortable.

Your anesthesiologist will discuss the options with you and recommend the safest and most appropriate choice based on your health status and preferences.

Day Before Surgery

The evening before surgery, follow the fasting instructions provided by your surgical center - typically nothing to eat or drink after midnight. Prepare your home for the recovery period by placing frequently needed items within easy reach. Consider arranging for someone to help with cooking, driving, and daily tasks for at least the first week.

Remove all jewelry from the hand and arm being operated on. Leave valuables at home and wear comfortable, loose-fitting clothing with short sleeves or sleeves that can easily roll up. Bring your splint or brace if you were provided one before surgery.

What Happens During Thumb Arthritis Surgery?

During thumb arthritis surgery, a small incision is made at the thumb base, the damaged trapezium bone is removed, and depending on the specific procedure, additional steps such as tendon reconstruction may be performed. The operation typically takes 45-90 minutes and is usually performed as a day surgery procedure.

Understanding what happens during surgery can help alleviate anxiety. While you won't be aware of the procedure if under general anesthesia or sedation, knowing the surgical steps can help you understand the recovery process and why certain restrictions are necessary.

Surgical Steps for Trapeziectomy

The surgical procedure follows a carefully planned sequence to ensure optimal results while minimizing complications. The surgeon begins by making a small incision, typically 3-4 centimeters long, over the base of the thumb on the back or side of the hand. The incision is positioned to provide good access to the joint while avoiding important structures.

After the skin incision, the surgeon carefully identifies and protects the radial artery, sensory nerves, and tendons that cross the surgical field. The joint capsule is opened to expose the trapezium bone, which is then meticulously removed, either in one piece or in sections, while protecting surrounding structures.

Once the trapezium is removed, the surgeon assesses the surrounding joints for any additional arthritis. If LRTI is planned, a tendon is harvested through a separate small incision in the forearm and used to reconstruct the ligaments and fill the space left by the removed bone.

The wound is closed with sutures, and a bulky dressing and splint are applied to protect the thumb in a position that promotes healing. The entire procedure typically takes 45-90 minutes depending on the complexity and specific technique used.

What Is Recovery Like After Thumb Arthritis Surgery?

Recovery after thumb arthritis surgery involves wearing a splint for 4-6 weeks, followed by 8-12 weeks of physical therapy. Most patients return to light daily activities within 6-8 weeks, desk work within 2-4 weeks, and achieve full recovery with improved grip strength within 6-12 months.

Recovery from thumb arthritis surgery is a gradual process that requires patience and commitment to rehabilitation. Understanding the typical timeline can help set realistic expectations and ensure you're progressing appropriately.

First Two Weeks

The initial recovery phase focuses on wound healing and managing post-operative swelling and pain. Keep your hand elevated above heart level as much as possible - this significantly reduces swelling and discomfort. Ice can be applied around the dressing (not directly on the wound) for 15-20 minutes several times daily.

Pain is typically well-controlled with prescribed medications. Many patients find that post-operative pain is actually less severe than the chronic pain they experienced before surgery, which can be encouraging. Follow your surgeon's instructions regarding wound care and dressing changes.

Avoid getting the wound wet until cleared by your surgeon. You may shower with a waterproof covering over the dressing. Finger movement is usually encouraged from the first day - gently moving your uninvolved fingers helps maintain mobility and reduce stiffness.

Weeks 2-6: Immobilization Phase

You'll typically see your surgeon 10-14 days after surgery to have sutures removed and assess wound healing. A custom-molded thermoplastic splint will replace the bulky post-operative dressing. This splint immobilizes the thumb while allowing some finger movement.

During this phase, the soft tissues are healing and the thumb needs protection. You can typically perform light activities using your fingers while keeping the thumb immobilized in the splint. Driving is usually not permitted during this phase as you cannot safely grip the steering wheel.

Light desk work may be possible within 2-4 weeks, depending on your job requirements and ability to perform tasks one-handed or with limited thumb use. Jobs requiring manual labor or heavy hand use will require longer time off.

Weeks 6-12: Rehabilitation Phase

Around six weeks post-surgery, you'll begin weaning out of the splint and starting formal hand therapy. A certified hand therapist will guide you through exercises designed to restore range of motion, strength, and function progressively.

Initial exercises focus on gentle range of motion - moving the thumb through its full arc in all directions. As healing progresses, strengthening exercises are gradually introduced. Therapy putty, resistance bands, and specific grip exercises help rebuild the muscles that support thumb function.

By 8-12 weeks, most patients have regained functional use of their hand for daily activities. Light gripping and pinching activities become possible, and the splint may only be needed for protection during strenuous activities.

Months 3-12: Continued Recovery

Strength continues to improve for 6-12 months after surgery. During this time, you'll gradually return to more demanding activities. Some patients notice continued improvement in grip strength even beyond one year.

Final grip strength typically reaches 70-90% of the non-operated hand, though many patients feel their function is better than before surgery due to the elimination of pain. The operated thumb may always feel slightly different from the other side, but most patients are very satisfied with the improvement in pain and function.

What Are the Risks and Complications of Thumb Arthritis Surgery?

Complications from thumb arthritis surgery are relatively uncommon but can include infection (1-2%), nerve injury causing numbness (5-10%), persistent pain or stiffness, thumb weakness, and complex regional pain syndrome. Most complications are minor and resolve with appropriate treatment.

Like any surgical procedure, thumb arthritis surgery carries some risks. However, the overall complication rate is low, and most patients experience excellent outcomes. Understanding potential complications helps you make an informed decision and recognize issues early if they occur.

Common Complications

The most frequent complication is temporary numbness or tingling in the thumb or back of the hand, occurring in approximately 5-10% of patients. This is usually due to irritation of small sensory nerves during surgery and typically resolves over several weeks to months. Permanent nerve injury causing lasting numbness is rare (less than 1%).

Wound healing problems occur occasionally, particularly in patients who smoke or have diabetes. Signs of infection include increasing redness, swelling, warmth, or drainage from the wound, and should be reported to your surgeon promptly. Infection rates are approximately 1-2% and are typically treated successfully with antibiotics.

Some patients experience persistent stiffness or weakness, though this usually improves with continued therapy. Scar sensitivity around the incision is common initially but typically decreases over time with scar massage and desensitization techniques taught by your hand therapist.

Less Common Complications

Complex Regional Pain Syndrome (CRPS) is a rare but serious complication involving chronic pain, swelling, and sensitivity that exceeds what would be expected from surgery. CRPS occurs in approximately 1-5% of hand surgery patients and requires specialized treatment if it develops.

Proximal metacarpal migration (shortening of the thumb) can occur after trapeziectomy as the metacarpal bone settles into the space left by the removed trapezium. While this is common radiographically, it rarely causes functional problems, and studies have not shown a correlation between migration and clinical outcomes.

In cases of joint replacement, implant-specific complications including loosening, dislocation, or wear can occur, potentially requiring revision surgery. This is one reason trapeziectomy remains the preferred procedure for most patients despite its longer track record.

What Results Can I Expect from Thumb Arthritis Surgery?

Long-term studies show 85-95% of patients achieve significant pain relief and improved function after thumb arthritis surgery. Most patients report high satisfaction levels, with pain scores typically improving from severe (7-8/10) to mild or none (0-2/10). Grip and pinch strength improve significantly, and most patients can return to their previous activities.

Understanding realistic expectations is crucial for satisfaction with surgical outcomes. Research consistently shows that thumb arthritis surgery produces reliable improvements in pain and function for the majority of patients.

Pain Relief

Pain reduction is the most consistent and satisfying outcome of surgery. Studies report that 85-95% of patients experience significant or complete pain relief. Patients typically describe their pre-operative pain as severe (7-8 out of 10), while post-operative pain ratings typically fall to mild or none (0-2 out of 10).

The improvement in pain allows patients to return to activities they had given up, sleep better, and experience improved quality of life. Many patients describe the relief as "life-changing" after years of struggling with painful, limited thumb function.

Functional Improvement

Grip strength and pinch strength both improve after surgery, though full recovery takes 6-12 months. Final grip strength typically reaches 70-90% of the non-operated hand. More importantly, the ability to use the thumb without pain allows patients to perform activities that were previously impossible or avoided.

Range of motion is generally well-preserved, particularly for simple trapeziectomy. Some procedures like arthrodesis intentionally sacrifice motion for stability, which is acceptable for patients prioritizing strength and pain relief over maximum mobility.

Patient Satisfaction

Long-term studies consistently show high patient satisfaction rates of 90-95% following thumb arthritis surgery. Patients report improved ability to perform daily activities such as opening jars, turning keys, writing, and gripping objects. Most patients state they would choose surgery again and recommend it to others with similar problems.

The durability of results is excellent - studies with 10-20 year follow-up show maintained pain relief and function, with very low rates of revision surgery needed. This makes trapeziectomy one of the most reliable procedures in hand surgery.

What Are the Non-Surgical Alternatives to Thumb Arthritis Surgery?

Non-surgical treatments for thumb arthritis include splinting, anti-inflammatory medications, corticosteroid injections, hand therapy, and activity modification. These conservative measures are effective for many patients, particularly in early-stage disease, and should be tried before considering surgery.

Surgery is typically reserved for patients who have not responded adequately to conservative treatment. Understanding these alternatives helps you explore all options and make an informed decision about whether surgery is right for you.

Splinting and Bracing

Thumb splints or braces support the CMC joint and reduce painful movements. Different designs are available, from soft neoprene supports for mild symptoms to rigid thermoplastic splints for more significant arthritis. Splints are typically worn during activities that aggravate pain and at night.

Studies show that splinting can reduce pain by 30-50% in many patients and may slow disease progression by reducing joint stress. Custom-fitted splints made by a hand therapist often provide better support and comfort than over-the-counter options.

Medications

Oral anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen can reduce pain and inflammation. These should be used at the lowest effective dose for the shortest duration needed due to potential side effects with long-term use. Topical NSAIDs applied directly to the thumb base may provide relief with fewer systemic side effects.

Acetaminophen (paracetamol) is an alternative for patients who cannot take NSAIDs. While less effective for inflammation, it provides pain relief with a different side effect profile.

Corticosteroid Injections

Injection of corticosteroid medication directly into the CMC joint can provide significant pain relief lasting weeks to months. While injections don't cure arthritis, they can reduce inflammation and allow patients to participate in therapy and maintain function.

Most physicians limit the number of injections to 3-4 per year due to potential effects on cartilage and surrounding tissues with repeated use. Injections are often most helpful for managing flare-ups or as a bridge while considering surgery.

Hand Therapy

A certified hand therapist can provide exercises to maintain mobility and strengthen the muscles supporting the thumb. Therapists also teach joint protection techniques and activity modifications that reduce stress on the arthritic joint.

Other treatments that may provide relief include heat or cold application, paraffin wax baths, ultrasound, and gentle massage. While evidence for some of these treatments is limited, many patients find them helpful as part of a comprehensive management plan.