An even newer option is a spacer made of Artelon fibers, a urea-based polymer that becomes part of the body within about six years, as tissue grows into the spacer. The spacer is designed to sit between the bones in the thumb’s basal joint to preserve the bones and keep them from touching.

After his left thumb developed arthritis, in 2005 Kenny Grayson opted to try the Artelon fibers. Four years later, he say his pain is gone, but the strength has still not returned. “My doctor told me to give it six years,” says Grayson, who still delivers mail full time. “If it doesn’t get any better in the next two years, we might try something else.”

Joint Replacement: Still Developing

Thumb joint replacements have been available for about 20 years, and the materials used in the replacement parts continue to evolve. Part of the challenge of replacing the basal joint is that force applied to the tip of the thumb is multiplied 12 times at its base, making it difficult to design replacement parts that will last.

“The implants do well for a couple of years, but usually within 10 years they fail,” Dr. Hartigan said.

Other problems with replacements include dislocation of the implant, pain and weakness and stiffness after implantation.

A 2006 study published in the Journal of Hand Surgery reviewed 654 cases of thumb joint surgery that involved partial removal of the trapezium bone or addition of an implant. Within 12 years, a second operation was needed in 17 cases. Of those 17 repeat surgeries – which included complete removal of the trapezium bone or conversion to the “anchovy” surgery – 13 were successful.

Fusion: Locked; Pain Unloaded

If other options fail, or if a young adult who is very active would wear out an implant quickly, joint fusion is an option.

During this procedure, damaged bone tissue in the joint is removed and nearby healthy bones are attached using screws or wires. The bones then grow together, or fuse. The surgeon can set the bones so the thumb is permanently straight or slightly flexed. The thumb will no longer bend, but, with therapy, learning how to use it in new ways allows function for most activities.

While there are a range of options to consider when you need thumb surgery, the good news is that some 90 percent of people who go under the knife to find relief from arthritis pain are pleased with their results.

“What we do know,” Dr. Koman says, “is that many of the operations, performed on the right patients by the right surgeon provide excellent pain relief and improve function.”