Thumb Joint Replacement for Basilar Thumb Joint Arthritis

Thumb Joint Replacement
for Basilar Thumb Joint Arthritis

Introduction
Hand function is inseparably linked to the condition of the thumb carpometacarpal joint. Although fractures, ligament injuries, and rheumatologic processes may damage this important articulation, basal joint arthroplasty is most often performed to relieve pain and increase motion in joints damaged by osteoarthritis¹.

Considerations
Thumb joint replacement may be considered for:

	Impairment of the thumb basal joint with localized CMC bony changes.
	Localized pain and palpable crepitation during circumduction movement with axial compression of the of involved thumb ("grind test").
	Decreased motion, decreased pinch, and decreased grip strength.
	X-ray evidence of arthritic changes isolated to the trapeziometacarpal joint.

Procedure
The patient is placed supine on the operating table with the arm abducted 90 degrees over an arm table. A tourniquet is applied, and the patient's arm is prepared and draped out in the usual sterile manner. Either block, axillary block, or general anesthesia is preferred.

Post Operative Care
A thumb spica splint is worn continuously for 2 weeks. A removable thumb spica splint is worn for 4 weeks and removed for skin care and bathing. At 6 weeks post op, more aggressive use of the hand is encouraged. Unrestricted activity is allowed 8-12 weeks post-op. Hand therapy may be required to regain motion and strength.

¹Calandruccio, JH and Jobe, MT, "Arthroplasty of the Thumb Carpometacarpal Joint", Seminars in Arthroplasty, vol. 8, no. 2, 1997, pp. 135-47.

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