Cons

The procedure stabilizes the joint but does not repair damaged cartilage or bone.

• Ligament reconstruction and tendon interposition (LRTI)

In use for more than 40 years, LRTI is still the most commonly performed surgery for thumb arthritis. The goal is to remove the arthritic joint surfaces and replace them with a cushion of tissue that keeps the bones separated. To accomplish this, surgeons remove all or part of the trapezium bone in the wrist. A nearby tendon is detached at one end and then passed through a hole drilled in the thumb metacarpal, and the remaining length of tendon is rolled like an anchovy and placed into the space where the bone was removed.  

Who can benefit

Adults with moderate to severe arthritis who have pain and trouble pinching or gripping.

Pros

According to Dr. Ruch, LRTI has a 96 percent success rate. "Most patients achieve complete pain relief and mobility equal to that of a healthy thumb, with results lasting at least 15 to 20 years," he says. "A variety of surgical techniques have been proposed over the years, including different types of implants, but none are as reliable in the long term as LRTI. It's still considered the gold standard."

Cons

LRTI has a lengthy and sometimes painful recovery and rehabilitation period, including at least four weeks of wearing a thumb cast. Patients also may experience decreased pinch strength and gradual shortening of the length of the thumb. When the entire trapezium is removed, there are few repair options if symptoms persist after surgery.

• Fusion (arthrodesis)

Instead of repairing or reconstructing a damaged joint, arthrodesis eliminates pain by fusing the bones in the joint together. A socket is created by hollowing out the metacarpal bone in the thumb and the trapezium is shaped into a cone that fits inside the socket. A metal pin holds the bones together to maintain proper alignment and prevent movement during the fusion process.

Who can benefit

Younger patients who are very active, have posttraumatic arthritis or physically demanding jobs; people with RA and those for whom thumb reconstruction has failed.

Pros

Arthrodesis produces a stable, pain-free thumb that can successfully grasp and pinch.

Cons

The procedure has a relatively high complication rate, can damage nearby joints and causes loss of mobility in the CMC joint, including the ability to lay the palm flat and put the fingers and thumb together in a cone shape. Arthrodesis fails in 8 to 21 percent of people, requiring a repeat surgery.

• Hematoma and distraction arthroplasty

In this simple, somewhat controversial procedure, surgeons remove the trapezium bone in the wrist and, with a wire, temporarily immobilize the thumb metacarpal in an overcorrected position. The wire is removed six weeks later. The idea is that without the constant friction caused in part by the trapezium, the body can heal itself.