I've heard that it's possible to have a thumb joint replacement these days. I'm giving it serious consideration for my severe thumb arthritis. Can you give me a quick run-down on these babies?
Pain, swelling, and loss of motion at the base of the thumb describe symptoms of carpometacarpal osteoarthritis (CMC OA) otherwise known as thumb arthritis. Just try and get along on a single day without being able to use your thumb. Everything from picking up a carton of milk to taking the handbrake off in the car can become impossible.
Over time, the thumb becomes weaker and weaker. With loss of normal strength, the thumb loses its anatomic alignment. Deformity and disability develop. Pretty soon even simple tasks such as picking up a piece of paper or turning a doorknob become impossible. That's when surgery becomes a viable option.
Because so many older adults develop arthritis at the base of the thumb with severe symptoms, surgeons have developed a variety of ways to surgically treat the problem. At last count, there were at least eight different procedures that could be used to treat thumb osteoarthritis. Joint replacement is one of them.
The first joint replacement (called arthroplasty) for the base of the thumb was developed in the early 1960s so you can see there's been about 50 years of research on this procedure. At first, there were many complications such as dislocations, fractures, and inflammation as the body reacted to the implant. Patients didn't get the pain relief or improved motion they had expected.
Since that time, studies show that patients recover faster when they get a joint replacement rather than having reconstructive surgery. Better strength, better motion, and better function are reported when joint replacement is compared with removing the trapezium bone and filling in the hole with a soft tissue graft.
There are stil some potential problems with joint implants for the thumb. The joint prosthesis can come loose, shift, or sink down into the bone. Some patients experience a reaction as the body views the implant as a foreign object and mount an immune defense against it. Any of these complications can spell disaster for the outcomes. To combat these issues, improvements have been made in implant materials and design in the last few years.
For now, it looks like short-term results for joint replacement are better than for removing the trapezium bone and/or reconstructing the joint. What we don't have yet are long-term results of joint replacement for the thumb using the newer implant design and surgical techniques. More studies are needed to really find out what works best over time for the problem of thumb arthritis. Experts in this area have called for better ways to measure results, especially related to hand function.
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.
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