Osteoarthritis of the hand most commonly involves the thumb basilar joints and sometimes also the finger distal interphalangeal joints. During the early stages of arthritis, people have pain and tenderness about the base of the thumb, which limits their strength and use of the thumb. As the arthritis progresses, people lose motion, and the thumb basilar joint may become unstable and subluxate. With advanced osteoarthritis, the thumb basilar joint becomes prominent, painful and stiff, sometimes with compensatory hyperextension of the adjacent thumb metacarpal- phalangeal joint.
Fortunately, there are good surgical remedies for the thumb when conservative measures, such as nonsteroidal anti-inflammatory medication, activity limitations, splints and injections no longer suffice. It is important to rule out other common causes of thumb pain, such as carpal tunnel syndrome, trigger thumb and de Quervain’s tenosynovitis, which do not show on x-rays, especially since the surgical remedies for those conditions are more minor with a quicker recovery.
The surgical options for thumb basilar joint osteoarthritis include various arthroplasties, which preserve motion, versus arthrodesis (fusion), which restricts motion but is durable and is still done in some younger patients. The more commonly done arthroplasty procedures all include removing all or part of the trapezium bone from the wrist and replacing it with either an implant or a living fibrous joint created by hematoma or tendon interposition. By creating a living fibrous joint at the base of the thumb, a surgeon can eliminate the concerns that an implant may fail or loosen over time.
Longview Orthopedic Associates has two decades of experience doing thumb basilar joint arthroplasties that include resection of the trapezium and temporary suspension of the thumb metacarpal base with pins to allow for the desired hematoma and eventual living fibrous joint to form. Our success rate has been very high, and the surgery can be done through a cosmetic transverse incision in line with skin creases. Patients usually spend two months in splints/casts postoperatively, with the pins in place for the first month and then easily removed in the office. We have been pleased with the good range of motion and stability that patients gain in the newly created thumb basilar joint, in addition to the resolution of pain from the arthritis. In cases of more advanced osteoarthritis with zigzag deformity of the thumb, additional surgery may be needed to prevent hyperextension of the metacarpal-phalangeal joint, although that should heal during the same period of splinting/casting and recovery. We invite patients to come in to Longview Orthopedic Associates for evaluation and consultation about thumb basilar joint osteoarthritis.