Thumb surgery for osteoarthritis

Marc Darrow, MD, JD

Most of the people that contact our office looking for treatment for their thumb pain have already had a long history of treatments with limited success. In fact, many will confess that their doctors are now recommending pain management (anti-inflammatories and painkillers) as their primary treatments now that splints, physical therapy, and a generous amount of ice are no longer helping. These people will receive pain management until the decision is made to go to surgery or “live with it.” For many, the benchmark of when to proceed to surgery is when cortisone injections fail to offer relief and is in fact giving the person more pain.

So what do we do for these bone on bone thumb people who have basically lost the use of the hands because they have no grip strength and are being pain managed? We offer a physical examination, and assessment of their pain and functional challenges, and when appropriate a recommendation for treatment.

A June 2024 study (1) explored the long-term changes in pain and hand function over a 2-year period in patients with thumb osteoarthritis. The researchers looked at those who received occupational therapy or brief information on how to manage their thumb pain while waiting for a surgical consultation. When comparing groups receiving occupational therapy only, occupational therapy and surgery, brief information only, and brief information and surgery, patients receiving brief information and surgery had significantly more pain and poorer function at four months compared to the other groups, whereas no difference was found between the four groups at 24 months. (Eventually the occupational; therapy and surgery performed equally).

In patients who received surgery after having received occupational therapy, pain and function did not change between 4 and 24 months, suggesting that surgery did not provide additional improvement in this group.

What the researchers suggested was that a patient’s thumb pain could be managed equally with or without surgery.

A September 2020 study (2) says this: “Resection arthroplasty (a joint replacement where the bones of the thumb may be repositioned at the same time) still is the gold standard for the treatment of basal thumb arthritis. In most patients, satisfactory results can be expected. However, the few patients with persisting problems are a challenge for the hand surgeon. They may complain of neuromas, tendinitis of the flexor carpi radialis (FCR) tendon, impingement and/or proximalization of the first metacarpal, arthritis of the scaphotrapezoidal joint or carpal collapse in the case of pre-existing scapholunate instability.”

Trapeziometacarpal joint osteoarthritis or rhizarthrosis is degeneration at the trapezium bone at the wrist and the first metacarpal bone of the thumb. The Trapeziometacarpal joint is a tricky joint to repair with surgery. This according to surgeons publishing research in the American Journal of hand surgery (June 2019). The surgeons expressed concerns that failure rates of trapeziometacarpal implants were considered high because of aseptic loosening, dislocation, and persisting pain.(3) This followed an April 2018 study (4) that also questioned whether thumb joint replacement surgery at the trapeziometacarpal joint provided significant benefits for the patient.

A brief look at this study reveals that doctors looked at four women diagnosed with stage III osteoarthritis at the Trapeziometacarpal who underwent total joint replacement surgery.

• What the surgeons found was the surgery was able to restore some thumb function but did not fully replicate the movements of a healthy trapeziometacarpal joint.

A February 2022 paper (5) added: “Until further high-quality research indicates otherwise, simple trapeziectomy should be the preferred surgical modality for base of the thumb arthritis.”

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References

1 Tveter AT, Østerås N, Nossum R, Eide RE, Klokkeide Å, Matre KH, Olsen M, Kjeken I. Long‐term changes in pain and function in patients with thumb base osteoarthritis receiving brief information, occupational therapy and/or surgery. Musculoskeletal Care. 2024 Jun;22(2):e1883.
2 Löw S, Kiesel S, Spies CK. Revision surgery after resection arthroplasty of the thumb saddle joint. Der Orthopade. 2020 Sep 1;49(9):762-70.
3 Ganhewa AD, Wu R, Chae MP, Tobin V, Miller GS, Smith JA, Rozen WM, Hunter-Smith DJ. Failure Rates of Base of Thumb Arthritis Surgery: A Systematic Review. The Journal of hand surgery. 2019 Jun 28.
4 D’Agostino P, Dourthe B, Kerkhof F, Vereecke EE, Stockmans F. Impact of Osteoarthritis and Total Joint Arthroplasty on the Kinematics of the Trapeziometacarpal Joint: A Pilot Study. The Journal of hand surgery. 2018 Apr 1;43(4):382-e1.
5 Challoumas D, Murray E, Ng N, Putti A, Millar N. A Meta-analysis of Surgical Interventions for Base of Thumb Arthritis. Journal of Wrist Surgery. 2022 Feb 23;11(06):550-60.