Surgical and Non-Surgical Treatment of Basal Joint Arthritis of the Thumb
Osteoarthritis is often called the wear-and-tear arthritis and most often hits the weight-bearing joints like the hips and knees. However, osteoarthritis of the trapeziometacarpal joint, the joint at the base of the thumb, is quite common, particularly among women who are past menopause. Treatment of osteoarthritis of the base of the thumb is almost always first non-surgical. This means trying anti-inflammatory medications, steroid injections, and maybe splinting the thumb. Exercises may also be recommended. It is only if there is no improvement or if the conditions worsen, that surgery should be considered. At that point, the surgeon must decide which is the best type of surgery for each particular patient. For example, if someone is a manual worker and depends on the strength of his or her hands and fingers, then the surgery that favors strength of mobility will likely be chosen.
The trapezuinetacarpal arthroscopy is an arthroscopic surgery, which means it is done with tiny incisions and the surgeon uses small narrow instruments to see inside the joint and make the repairs. This surgery is often preferred because, unlike an open incision, it is minimally invasive and has a lower chance of complications like injuring the nerves around the joint. At the same time, the doctor can have a good look around and sometimes diagnose problems in the cartilage before they could be picked up by x-rays or other tests.
With arthroscopic surgery, surgeons can debride the area, remove any tissue that has broken away or become damaged. According to several studies, arthroscopic surgery has a success rate similar to the open surgery procedures.
Another type of surgery is the metacarpal osteotomy, where the surgeon tightens the ligament, the tissue that connects the muscle to bone. If this is done in the early stages of osteoarthritis, in Stage 1, the results are promising. Ligament reconstruction is another option available to the surgeons. This is, as the name says, a reconstruction of the ligament but it is only successful in the early stages, Stage 1 and 2. The doctors feel that this surgery can help slow down the disease progression.
A trapeziectomy is done to relieve pain, but it can result in a weaker thumb. The surgeon must shorten the bone somewhat, which can also cause instability of the joint and further deterioration in the joint. This may be solved with the trapezietomy and ligament reconstruction, which is often done for stages 2 to 4 of the disease. By reconstructing the ligament, the thumb shouldn't weaken, but there aren't any studies that have backed this up as yet.
Two other procedures are called the trapeziometacarpal arthodesis and the trapeziometacarpal implant arthroplasty. The first, the arthrodesis, is a fusion of the thumb at the joint. This can help make the thumb strong, but limits the movement available. Studies have yet to come up with solid proof that this is an effective treatment. The second, the arthroplasty, is a joint replacement of the thumb joint. While this does help relieve pain, there are some problems associated with the replacement, such as loosening of the implant. The loosening has been a concern, particularly among men and younger women. Some researchers say that it should be done only in women who are over 60 years old, to avoid this problem.
In conclusion, the authors of this article wrote that it is agreed that non-surgical management of osteoarthritis of the base of the thumb should be the first choice. Surgery is only to be done if the non-surgical management doesn't work. However, more studies are needed to be able to adequately compare the different types of surgical procedures to come up with recommendations as to which are better than others.
Soham Gangopadhyay and Tim R.C. Davis. Advances in treatment of basal joint arthritis of the thumb. In Current Orthopaedic Practice. September/October 2008. Vol. 19. No. 5. Pp. 503-508.