Saturday, 25 May 2013

OA at the base of the thumb - Carpometacarpal suspension arthroplasty

When I went to see the hand surgeon recently his advice was the same as it had been five years ago.  He had told me then that it was not a good idea for him to operate on my thumb or my knuckles until my wrists were fused. This year I went ahead with a fusion on the left wrist.

The thumb operation recommended was a suspension arthroplasty.

You can see how the base of my thumb is squared off in the picture.  That is likely a result of osteoarthritis, which is all too common with rheumatoid disease.  My friend had an operation to repair one thumb last fall and the other thumb was repaired just last week.  Prior to the procedure she had a lot of pain with bone rubbing on bone.  She has shared her experience with me and I am telling her story.  Here is a picture of her hands with the right one after the operation and the left one still to be done. The pain in her right hand is much less now.

"The name of my surgery is suspension arthroplasty of the carpometacarpal joint of the thumb and there are quite a number of different ways to do it.  The doctor recommended it highly because there is no new joint, just removal of the one rubbing which was a small joint just below the CMC called the trapezium as well as part of the scaphoid and strengthening it by drilling a hole and putting a tendon through one of the joints to stabilize it.

My hand is pretty good now. Healing is progressing more slowly than at first and may never be perfect but I don't care because it is doing quite well without the offending joint. I have quite a bit more strength, dexterity and range of motion and I am grateful that there was a solution for me.

The doctor recommended against joint replacement for my thumb and it made eminent sense – there is no artificial joint, therefore nothing can go wrong or need replacement. He said suspension arthroplasty is an ideal solution for my problem.
                             OA in CarpoMetacarpal Joint
After surgery I did have numbness on the top of thumb and it was overly sensitive from first joint down to wrist. That is lessening now.  The pain in the rest of my body is less since the operation and it makes me wonder if pain in one area makes everything else more sensitive; conversely, reducing pain in one area may reduce it everywhere.  It is worth hoping.
Other doctors I saw for advice had never heard of suspension arthroplasty for thumbs and didn't know what a good solution it has been; They recommended against surgery. 
                                               Grover,the grumpy Texan cat
I agree with the doctor calling his offer of surgery on my thumb a “treatment”. For the surgery, I had no alternative unless I wanted to live as a grumpy invalid. It was unpleasant to go through but the alternative was so much worse, the decision was easy. I’m sure I was as afraid of surgery as anyone. After three months, I have very little pain in the thumb and it’s almost completely functional.
Up with surgery and drugs! Down with pain!

I had a cast to the elbow with only the joints of my fingers free for three weeks and then a hard splint with similar directions for protection for another three weeks."

Links to more information:

Suspension arthroplasty is a term describing the use of a slip of tendon to reconstruct elements of the ligament supports of the base of the thumb. There have been many techniques described, but no published study shows a clear advantage of one technique over another for all cases. Most specialist surgeons working in this area do however prefer to reconstruct the ligaments, in the belief that for those patients for whom it succeeds, better overall strength is achieved in the hand for grip and pinch. This is still a developing area though.

CMC Arthroplasty of the Thumb: A Review

Suspension arthroplasty of the thumb carpometacarpal joint: modified surgical technique, follow-up treatment and results--a retrospective analysis of 51 operations

Rehabilitation protocol after suspension arthroplasty of thumb carpometacarpal joint osteoarthritis.


  1. It's good to see the outcomes of surgery in pictures Annette, thank you to your friend for sharing her story and photos. As you know I've yet to have any joint surgery, but I know that I will likely have to at some point and posts like this are great to enlighten those of us who are still surgery virgins.

  2. I'll thank her Gilly. She's just recovering from having the second one done. She had a lot of pain for years and was so pleased with the result of the first she went ahead. Needs help but has meals for 30 days put by in her freezer. Great at thinking ahead.

    I have another friend lined up to tell me about her elbow surgery.