In the management of basal joint arthritis, several non-surgical treatments can be proposed to relieve pain and preserve the mobility of the thumb :
such as wearing a brace or splint, injections or physiotherapy.
But when these solutions are no longer enough, surgery may be considered.
Knowing when to consult a hand surgeon makes it possible to better anticipate the progression of the condition and to prevent discomfort from setting in permanently.
This page is an extension of the ‘Treatment and care’ section, and complements the information offered in our main section ‘Basal joint arthritis – a form of arthritis that affects the joint at the base of the thumb’.
When should you consider thumb surgery?
An operation is never proposed as first-line treatment.
It generally happens in the second line, when conservative approaches no longer effectively relieve pain or help maintain functional use of the thumb.
There are certain signs to look out for requiring a specialist consultation:
You don’t need to wait for a total loss of mobility or extreme pain to book a consultation.
It may even be worth consulting a surgeon beforehand to assess the options and anticipate the possibility of a surgical procedure to avoid hasty decisions.
Who should I contact for advice on surgery?
The most competent professional to determine the need for surgery is a specialised orthopaedic hand surgeon.
They know the trapeziometacarpal joint and the surgical procedures adapted to basal joint arthritis inside out.
During the consultation, this specialist will be able to:
The website features a hand surgeon directory to help you find a professional near you.
What are the possible operations?
Surgery is always adapted on a case-by-case basis, depending on:
The most widely used techniques include:
The trapeziometacarpal or TMC prosthesis
This involves replacing the worn joint with an implant designed to restore the mobility of the thumb.
It is a technique that is increasingly being proposed, especially in active patients, with often rapid and satisfactory results in terms of pain, strength and hand movement.
More details on the ‘TMC prosthesis: how it works and results’ page.
Trapeziectomy (with or without ligamentoplasty)
This involves removing the trapezium bone to prevent painful rubbing. This can be complemented by tendon interposition or suspension to stabilise the thumb.
It is a proven, durable technique that is often preferred when a prosthesis is contraindicated.
Joint fusion, keyhole surgery, partial trapeziectomy, etc. These alternatives are discussed on a case-by-case basis with the surgeon.
The choice between a trapeziectomy and a prosthesis also depends on the condition of the neighbouring joints, in particular the scaphotrapeziotrapezoid (STT) joint. An associated impairment may influence the decision to operate.
To find out more about these two techniques see: Trapeziectomy or TMC prosthesis?
Surgery: a shared decision
The decision to operate is neither based solely on the pain experienced, nor solely on radiology images.
It is made in a conversation between the patient and the surgeon, taking into account:
This time for discussion makes it possible to choose the right moment to consider an operation, and above all the most appropriate technique.
What to expect after surgery
Like any surgery, basal joint arthritis surgery requires a gradual recovery, which varies according to the technique chosen.
It generally includes :
To help you prepare :
