Thumb joint replacement involves removing the damaged joint surfaces and replacing them with an artificial implant, typically made from metal, plastic, or ceramic. The procedure is mostly performed on the basal joint at the base of the thumb, which is frequently affected by osteoarthritis.

A thumb joint replacement is typically recommended when conservative treatments have failed to provide lasting relief from severe thumb arthritis. Symptoms that may indicate a need for surgery include:

• Chronic pain at the base of the thumb that does not respond to non-surgical options
• Reduced pinch and grip strength
• Decreased range of motion or stiffness
• Painful grinding sensation in the joint
• Deformity of the thumb

Total joint replacement is often the preferred option for patients with moderate to severe thumb arthritis who want to achieve significant pain relief and improved overall function. This is for patients that have not responded to non-surgical treatments such as medication, injections, or splinting.

Thumb base arthritis, or carpometacarpal (CMC) arthritis, is primarily caused by the long-term wear and tear of the cartilage in the joint at the base of the thumb. However, it is not a single factor but a combination of several issues that can contribute to its development. This can include age, genetics, repetitive stress, previous injuries, gender and hormones, inflammatory disease and joint hypermobility.

In all cases, the decision to undergo surgery depends on a careful evaluation of the patient's condition and goals.

1. Severity of arthritis: The procedures are used for advanced arthritis where conservative treatments have failed
2. Level of functional demand: A patient's lifestyle and hobbies are a major consideration. Those who need high levels of strength may be better suited for an arthrodesis (joint fusion), while those with more moderate demands may benefit more from replacement
3. Pre-existing conditions: Any other wrist or finger arthritis could affect the choice of procedure
4. Bone stock and quality: A Surgeon must ensure that the trapezium bone is healthy and large enough to support an implant
5. Overall health: Potential patients should be in good general health and have a clear understanding of the risks and benefits

Thumb joint replacement is an option after conservative treatments such as pain relief, physiotherapy and pain injections have not relieved symptoms adequately. Other alternative procedures that may be suitable dependent on your specific symptoms are trapeziectomy or thumb joint fusion.

During your initial consultation and diagnosis, you will discuss all the options available to you with your expert Surgeon and come to an agreement on the choice of a surgical intervention. Our expert, caring team will give you instructions on how to prepare for surgery. It is important at this stage to discuss any concerns or ask any questions you may have.

When you arrive for your appointment or treatment, you can be assured that we will maintain your privacy and dignity. Our team are there to ensure that your care and treatment is delivered in a safe and effective way and we will make sure you have transparent information on all aspects of your procedure.

1. Anaesthesia: The surgery begins with the administration of general anaesthesia, which puts you to sleep. This is a day case procedure
2. Incision: Your Surgeon will make a small incision, about 3cm long, near the base of your thumb to access the affected CMC joint
3. Joint preparation: The Surgeon carefully exposes the joint and removes the damaged cartilage and bone. In a total joint replacement, both the metacarpal bone of the thumb and the trapezium bone of the wrist are prepared to receive the new implant
4. Implant placement: A prosthetic implant, often consisting of a metal stem and a cup, is then secured in place
5. Stem: A canal is created in the metacarpal bone of the thumb, and a stem is inserted
6. Cup: A socket is created in the trapezium bone of the wrist, and the cup is impacted into it
7. Joint function: The ball of the implant, which is attached to the thumb's metacarpal, then sits within the cup in the trapezium, restoring the joint's function
8. Closure: Once the implant is securely in place, the surgeon closes the incision with sutures. A dressing is applied, and a cast or splint is put on to immobilise the thumb and aid in healing

For the first one to two weeks, your hand will be kept in bulky bandage. After this, the dressings will be reduced in the physiotherapy clinic. At this point, you may be left free, if comfortable, but if a little sore then a removable splint can be used for a short period. You will need to keep the area elevated to control pain and swelling. After the initial immobilisation period, it is recommended you begin working with a hand therapist. Therapy focuses on regaining motion and strength in your thumb.

While many patients return to most activities within six to 12 weeks, full recovery and strength can take up to three months.

It’s likely you won’t be able to drive until at least two weeks after thumb joint replacement surgery. Test how difficult it is to grip your steering wheel; would you be able to carry out an emergency manoeuvre, does changing gear or turning on indicators worsen pain? If your answer is yes to any of these self-assessments, it’s worth waiting until you’re more healed to drive.

You’re welcome to bring someone with you to your appointment so they can wait with you, and it’s advisable so that you have someone who can drive you home. However, they will need to remain in the waiting area during your procedure.