Arthritis is a condition characterized by joint inflammation, stiffness, and pain. Arthritis can affect many joints in the body including the hips, knees, ankles, elbows and thumb. Having arthritis of the thumb severely limits the range of motion of the thumb, causing normal actions, such as grasping and pinching, to be limited. While many patients with arthritis can be treated with medication and physical therapy alone, in some cases, surgery is necessary. There are five major types of surgery for the thumb.
1. Ligament Reconstruction
Ligament reconstruction is a type of surgery that stabilizes the thumb joint by taking out a portion of the damaged ligament and replacing it with the patient’s wrist flexor tendon. This tendon helps reconnect and restore the function of the thumb with the rest of the hand.
The ideal candidates for a ligament reconstruction are patients who have no loss of cartilage (soft cushioning of the joint) and whose symptoms develop due to joint laxity. The advantage of undergoing a ligament reconstruction is that is provides significant pain relief and has been shown to prevent disease progression. The disadvantage of a ligament reconstruction is that while the surgery stabilizes the joint, it does not repair the damaged bone.
2. Ligament Reconstruction and Tendon Interposition (LRTI)
An LRTI is the most common surgery for patients with arthritis of the thumb. In an LRTI, the arthritic joint is removed and replaced with a cushioning tissue that keeps the bones separated. The ideal candidate for LRTI is a patient with moderate to severe arthritis who experiences pain or difficulty when it comes to pinching or gripping.
The advantage of LRTI is is that it eliminates the possibility of arthritis returning and the procedure has a 96 percent success rate. In fact, most patients experience complete pain relief and improved mobility, similar to that of a healthy thumb. Furthermore, these results can last at least 15 to 20 years. However, LRTI can also have a long and painful recovery and patients generally have to wear a thumb cast for at least four weeks. Patients can also experience reduced strength for pinching, causing difficulty when it comes to grasping and holding objects. Furthermore, LRTI shortens the thumb, which can lead to some issues.
3. Hematoma and Distraction Arthroplasty
This is a controversial procedure in which surgeons temporarily immobilize the thumb using a wire. Six weeks later, the wire is removed. If the friction between the joints is removed, the body can heal itself, and this is the ultimate goal of a hematoma and distraction arthroplasty.
The ideal candidates for this procedure include patients with moderate to severe arthritis who want a surgical procedure that is not very complicated. Patients tend to be older and less active and have had a failed reconstruction surgery. The advantages of this surgery are complete pain relief, improved grip strength, and improved function. Furthermore, there are less complications with the procedure in general. The disadvantages of this procedure are that patients can experience loss of pinch strength and thumb shortening.
4. Total Joint Replacement (Arthroplasty)
Similar to other types of joint replacement surgery, a total joint replacement of the thumb joint involves removing all or part of the damaged joint and replacing it with an implant. While earlier implants were made of silicone, surgeons currently use metal or pyrocarbon implants.
The ideal candidates for this type of procedure are older patients with few functional demands, as the implants fail when used heavily. The advantage of undergoing a total joint replacement of the thumb is that it is a less invasive surgery with a faster recovery and rehabilitation. The disadvantage of a total joint replacement is that in some groups of patients, it can have a high complication and failure rate, leading to bone damage, pain and inflammation.
5. Fusion (Arthrodesis)
Another surgery that can be performed is known as fusion, which reduces pain by fusing bones together in a joint. The ideal candidate for a fusion are younger and more active patients, who have posttraumatic arthritis or physical jobs (that can cause implants to wear out quickly), have rheumatoid arthritis, and have already undergone surgery but don’t experience relief.
The advantage of undergoing fusion is that it leads to a stable and pain-free thumb that can do basic things like grasp and pinch. The disadvantage of undergoing a fusion is that it has a relatively high complication rate, can damage joints, and can lead to a loss of range of motion and mobility. Finally, fusions tend to fail in eight to 21 percent of people, causing them to have to repeat their surgery.
Other treatments for arthritis of the thumb
Medication is almost exclusively used to relieve pain. Medication for arthritis of the thumb generally involves using topical (on the skin) medications (i.e. capsaicin or diclofenac), over-the-counter pain relievers (i.e. acetaminophen, ibuprofen, naproxen sodium) and prescription pain relievers (i.e. celecoxib, tramadol).
Splints help support the joint and restrict the movement of the hand and the wrist, leading to decreased pain, and improved position of the joint. Splints can be worn at night or throughout the day.
If your pain doesn’t respond to pain relievers or splints, then the doctor may recommend injection of a long-acting corticosteroid into the thumb joint. These injections can lead to temporary pain relief and a reduction in inflammation.