Houston Methodist. Leading Medicine

Hand FAQ

Question:

I'm faced with an important decision about my thumb arthritis: surgery to reconstruct the base of my thumb or joint replacement. I'm struggling to figure out which way to go. What do your experts think?

Answer:

The decision to reconstruct the carpometacarpal (CMC) joint versus replacement can be a difficult one. There are always pros and cons to every surgical procedure. And each patient is unique in his or her presentation, goals, and expectations. We recommend a frank conversation with your hand surgeon about these points. We can offer some information from a recent well-done systematic review that might help inform you when deciding what specific questions to ask your surgeon about your own situation. In this review, hand surgeons tally up the results of studies in this area published from 1966 to 2009. The surgical procedures included 1) removing the trapezium bone (trapeziectomy) and filling in the hole with a spacer or rolled up piece of ligament (interposition), 2) same procedure using a piece of tendon instead of ligament, 3) removal of the trapezium and ligament reconstruction, 4) just ligament reconstruction, or 5) trapeziectomy with both ligament reconstruction and tendon interposition. There were other surgical procedures as well such as an arthrodesis (joint fusion), joint replacement, or osteotomy. An osteotomy is the removal of a wedge-shaped piece of bone to help realign the entire bone and joint. Once the piece of bone is taken out, the remaining two edges of bone shift toward each other and change the structural alignment. After reviewing results of studies for each surgical procedure, the following conclusions were made:
  • Trapeziectomy is a commonly performed procedure but doesn't work any better than any other operation.
  • Likewise for trapeziectomy with tendon or ligament interposition -- there's no evidence that this is the best way to treat thumb arthritis.
  • If tendon tissue is used to fill the hole when the bone is removed, it's best to use graft tissue from the patient rather than from a donor bank. There are fewer problems, complications, and revisions.
  • Short-term results (first 12 months) aren't better when trapeziectomy with ligament reconstruction are done.
  • Trapeziectomy with both ligament reconstruction and tendon interposition had the highest rate of post-op complications.
  • Fusion of the carpometacarpal (CMC) joint had the highest rate of repeat surgeries, nonunions, and other problems.
  • Short-term results are better for joint replacement over trapeziectomy but no long-term studies have been done yet. At this point, there was no single surgical procedure that stood out as the best one to use for the problem of carpometacarpal (CMC) osteoarthritis (OA). In general, most of the studies only give results after a short period of time (one year). Your surgeon may have some better details for you based on his or her preferences and experience. That's always good information to have when making a decision like this one. Guus M. Vermeulen, MD, et al. Surgical Management of Primary Thumb Carpometacarpal Osteoarthritis: A Systematic Review. In Journal of Hand Surgery. January 2011. Vol. 36. No. 1. Pp. 157-169.

    *Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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