The Latest in Surgery for Basal Joint Arthritis

The joint at the base of the thumb is called the carpometacarpal joint (CMC). This is the joint where the thumb attaches to the wrist. It is also a common site of osteoarthritis (OA), especially among postmenopausal women.

In this article, two hand surgeons from the NYU Hospital for Joint Diseases review the anatomy and biomechanics of this joint. They also present two specific surgical techniques used to stabilize the joint.

The operations discussed include the volar ligament reconstruction (VLR) and the LRTI arthroplasty. LRTI stands for ligament reconstruction with tendon interposition.

The basic idea behind surgery is to remove part or all of the arthritic bone. The empty space where the bone was located must be filled in with tendon or other soft tissue material. Step-by-step instructions are provided for both operations. Detailed drawings are also included.

Surgery is done when conservative care has failed to reduce painful symptoms or to improve function. The type of surgery selected depends on how progressed the disease is. Stage I disease has not affected the joint capsule yet. This may be the ideal time to have surgery.

VLR is the best way to stabilize the joint at this stage. LRTI is another ligament reconstruction technique. It was developed to overcome the tendency of the thumb to shift toward the hole left by the bone removal.

These operations have been shown to help improve grip strength and function. Pain relief isn't always as much as hoped for or as expected. Long-term results show that two-thirds of all patients have pain or discomfort five to 15 years later.

Reference: 

Alexander S. Croog, MD, and Michael E. Rettig, MD. Newest Advances in the Operative Treatment of Basal Joint Arthritis. In Bulletin of the NYU Hospital for Joint Diseases. Supplement 2, 2007. Vol. 65. No. 1. Pp. 78-86.

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