Getting to grips with thumb arthritis

Arthritis at the base of the thumb joint is a common complaint and can often be helped effectively with non-surgical treatments. For those that have exhausted these options, surgery can offer good long-term pain relief and return to better function. An innovative technique is used to replace the joint with a ball and socket, much like a hip replacement. This allows a faster recovery than previous options and maintains flexibility and strength.

Mr Alistair Hunter is an orthopaedic consultant specialising in hand, wrist and elbow surgery at HCA UK’s The Princess Grace Hospital. 

"I see a lot of patients with pain in the thumb that isn't getting better or that’s actually getting worse with time." says Mr Hunter. "Thumb arthritis can cause real difficulty with function; I am often told by my patients 'I can't do my gardening,' or 'I can't play tennis anymore.'" Mr Hunter says, "We only realise how much we use the thumb when we can't use it."

There are several surgical options for base of thumb arthritis and a detailed assessment in the clinic allows the surgical procedure to be tailored to the individual. The examination of the thumb identifies potential causes for pain at the base of the joint. X-rays help confirm the diagnosis and the pattern of disease. "It's important to understand the anatomy of the patient’s condition to guide treatment decisions," states Mr Hunter.

The traditional surgical option is a trapeziectomy, which involves removing the small arthritic trapezium bone at the base of the thumb. While Mr Hunter does offer this traditional approach when appropriate, he also now offers the thumb joint replacement procedure. He feels it has transformed his practice. "Maybe 10 years ago, the technology and understanding weren’t quite there with the implants." says Mr Hunter. "Now, there is high quality evidence to show these implants work well into the long-term. The advantage of this procedure is that by restoring the alignment and balance of the thumb, we see better strength and a faster return to daily activities."

Recent changes to the implant design, including the dual mobility ball and socket construct, mean the risks of the procedure are lower. While it is generally very successful, there is always a small chance of dislocation, loosening or needing a revision operation later. "That's a conversation I have with the patient. Our aim is to explain how a procedure is likely to give the patient good long-term pain relief, what risks are involved and to manage their expectations for the long term," says Mr Hunter.

Joint replacement surgery was the best option for a recent patient of Mr Hunter. An active lady in her early 60s, she presented with arthritic pain in the base of her thumb. Previous treatment included physiotherapy, painkillers, changing her activities, and injections. She still found it difficult to continue with daily life and to do her desk-based work.

Mr Hunter and the patient decided to go ahead with a joint replacement operation after a thorough assessment and comprehensive discussion in his clinic. "The theatre and nursing staff are very experienced at The Princess Grace Hospital who support this procedure" says Mr Hunter. It was a day case procedure and, by review at two weeks, she was moving her thumb well, using a plastic moulded splint to support the joint to help relieve any pain. She was taking the splint off at regular opportunities and was completely off pain relief by the time of the review. 

The patient was back to most of her usual activities by about six weeks and the next few months were spent focusing on building up the strength of the hand. Mr Hunter and the hand therapy team make sure she continues to do well. "That's the kind of recovery that most patients could expect from this surgery," he says.

"We say to patients that we can treat their pain and get them back to enjoying activities and life again. They don’t just have to accept the pain. This is an important message; that there are ways through it and at HCA UK there is a lot of support for consultants delivering new and innovative techniques for joint replacement surgeries."

"If you ask hand surgeons about the base of the thumb joint, they may say it is what enables us to be human. If you look at monkeys and their hands, they are not able to oppose the finger and thumb. Humans are, and that means we can do so much more. But if we are not able to touch the thumb with the fingers, the hand is limited to grasping." These more sophisticated procedures ensure that this vital function can be reliably restored for those suffering with arthritis of the thumb.