Making Older Hands New Again: A Surgical Fix for Arthritic ThumbsFusion surgery, also called arthrodesis, is useful for treating advanced arthritis. Connecting the joint into one solid bone keeps the joint surfaces from rubbing together, causing pain.
This surgery works well for patients who have arthritis in the joint that forms the base of the thumb. This joint is named the trapeziometacarpus (TM) joint. In the past, fusion of the TM was only recommended for younger patients who had hand deformities or arthritis following a trauma. Doctors usually wouldn't recommend it for patients over 50. This mainly had to do with concerns that fusing the TM in older patients would cause arthritis in the nearby joints.
These authors began doing the procedure in patients over 40. They looked at surgery results of 49 patients (59 joints) with TM arthritis. There were 42 women and seven men. The average age was 54. (Ages ranged from 41 to 73.) Ten patients had surgery on both hands.
The authors followed up within 20 years to see how their patients were doing. Some of the patients had X-rays to make sure the bones had grown together and to check for signs of arthritis.
Of the 59 joints, four (seven percent) didn't heal back together properly. These four patients were all women who'd had bone grafts during surgery to improve the chances that the bones would heal together. Fortunately, three of the four patients were not in pain. The one in pain went on to have another surgery, which was successful.
X-rays of 27 patients showed that seven had signs of developing more thumb arthritis. However, these seven patients weren't having symptoms.
Pain was generally low at follow-up. When patients were asked to rate their pain on a 10-point scale, with one being no pain, the average response was 1.5. No patient said pain was higher than a six. The average for the patients whose X-rays showed arthritis was even a little lower than the norm at 1.4.
Patients were very satisfied with the surgery. All but one of them said they would have the surgery again given the same circumstances. The authors feel that this procedure provides excellent, lasting pain relief. Based on their results, the authors believe fusion surgery may be the right choice for older patients with arthritis in the base of the thumb.
David B. Fulton, MD, and Peter, J. Stern, MD. Trapeziometacarpal Arthrodesis in Primary Osteoarthritis: A Minimum Two-Year Follow-up Study. In The Journal of Hand Surgery. January 2001. Vol. 26A. No. 1. Pp. 109-114.
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