Thumbs up to total thumb joint replacement surgery
By GREGORY A. VOIT, MD
When it comes to total knee replacement and total hip replacement, most people know someone who has experienced one of those surgical procedures, but how many are aware of thumb joint replacement surgery?
Many joints in the hand are not amenable to satisfactory joint replacement. The thumb, however, because of its flexibility and importance in use of the hand, can benefit significantly from joint reconstruction.
The joint at the base of the thumb is the most commonly arthritic joint in the body. While anyone can be affected, thumb base arthritis is particularly common in women – especially women in their late 40s, 50s and 60s.
People often describe pain at the bottom of the thumb, worsened with pinching or gripping and with activities such as opening jars or using can openers. Any task requiring pinching, gripping or putting pressure on the thumb causes increased pain and associated weakness of pinch/grip.
Because of the length and leverage of the thumb, each pound of pressure at the thumb tip produces several times the pressure at the base of the thumb, which can be very painful to an arthritic, irritated, joint.
Joint replacement/reconstruction is performed when arthritic symptoms no longer respond to non-surgical management such as therapy, bracing, anti-inflammatory medication or cortisone injections. Several surgical options are available when non-surgical methods no longer provide relief.
An arthritic joint can be fused (solidly immobilized), or reconstructed by one of several methods, which retain motion. One of those, ligament reconstruction tendon interposition arthroplasty (LRTI) is a time tested, well studied option which reliably produces excellent pain relief and return of function.
The procedure removes the arthritic joint surfaces and replaces them with the patient’s tendon. The procedure moves the tendon to the arthritic space between the bones to resurface the involved joint and create a spacer comprised of the patient’s own tendon.
There are several significant benefits. The tendon is not prone to the mechanical wear or loosening associated with plastic or metal parts. Natural tendon retains its innate resistance to infection, lowering the risk of surgical infection.
Follow-up studies of 20 years demonstrate durable, lasting symptom relief and persistently good function. Complication rates are low and patient satisfaction with the procedure is generally excellent.
After surgery there is a significant recovery period. The thumb is casted, with a pin in place for one month, after which physical therapy is essential to regain flexibility and strength.
It is not unusual for the total course of treatment to take six to eight months, from beginning to end. However, thereafter, relief and return of function are generally excellent and long lasting.
No solution to any medical issue is right for everyone. But for patients with painful, limiting arthritis at the base of the thumb which interferes with the ability to be comfortable, sleep or perform personal or occupational activities, thumb reconstruction can be a reliable and satisfying option to relieve pain and restore function.
Several sources of information for self-education are available, including:
The American Society for Surgery of the Hand (http://www.assh.org/), American Academy of Orthopedic Surgeons (http://www.aaos.org/), or contact us Shore Orthopaedic University Associates at (609) 927-1991 or www.shoreorthodocs.com.