Question:Wow! I just found out the bones in the base of my thumb are disintegrating from arthritis. The doctor thinks surgery might be my only option. Just what kind of operation is available for this problem?
There are several different surgical ways to treat osteoarthritis (OA) of the trapeziometacarpal (TMC) joint. The two most common operations are tendon arthroplasty and TMC arthrodesis.
In a tendon arthroplasty the trapezium bone at the base of the thumb is taken out. A nearby tendon is split and used to stabilize the joint and fill in the gap. During an arthrodesis the TMC joint is fused together. There are some problems with both of these operations.
For example, studies show the thumb pinch remains weak years after the tendon arthroplasty. Arthrodesis gives a good pinch but many patients have trouble with pain and they can't flatten the palm down.
A newer treatment option is the use of a joint spacer. The trapezium is removed and a special biodegradable T-shaped insert is placed in the hole. The spacer gives a scaffold for the healing tissue to cling to while forming new joint cartilage. After a few years most of the implant breaks down. A recent study in Sweden showed this treatment option gave long-term pain relief while restoring motion and strength.Anders Nilsson, MD, PhD, et al. Results From a Degradable TMC Joint Spacer (Artelon) Compared with Tendon Arthroplasty. In Journal of Hand Surgery. March 2005. Vol. 30A. No. 2. Pp. 380-389.
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