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CMC Joint Arthroplasty-Relief for Thumb Arthritis Pain

CMC Joint Arthroplasty: A Surgical Solution for Thumb Arthritis

Written By Dr Athena AU

(Last updated on: November 12th ,2025)

Introdcution

Thumb-base arthritis, or carpometacarpal (CMC) joint arthritis, is a common and painful condition. When conservative treatments like splinting, medication, and therapy fail, surgery may be considered. CMC joint arthroplasty, or thumb joint replacement, is a leading surgical option aimed at relieving pain while preserving motion.

Surgical Treatment Options for Thumb Arthritis

The choice of surgery depends on the stage of arthritis and the patient's lifestyle. The main options are:

  1. Arthroscopy with Synovectomy & Thermal Shrinkage
    • Best for: Stage 1 (early) arthritis.
    • Pros: Minimally invasive, with a quicker recovery.
    • Cons :Not suitable for advanced arthritis; symptoms may recur.
  2. Joint Fusion (Arthrodesis)
    • Pros: Excellent pain relief and stability; ideal for heavy manual labour.
    • Cons :Permanent loss of thumb motion; longer recovery; may stress adjacent joints.
  3. Joint Replacement (CMC Arthroplasty)
    • Pros: Significant pain relief while preserving a near-normal range of motion; shorter initial rehabilitation; improves dexterity.
    • Cons :Risks of implant dislocation, wear, or loosening over time, potentially requiring revision surgery.

What is CMC Joint Arthroplasty Surgery?

CMC joint arthroplasty involves removing the damaged bone surfaces at the base of the thumb and replacing them with an artificial implant. Similar to a hip or knee replacement, the prosthesis is typically made of metal and is designed to restore pain-free function. It is primarily recommended for patients with intermediate to advanced arthritis who wish to maintain thumb mobility.

When to Consider CMC Joint Arthroplasty

Key indicators include:

  • Persistent pain that does not respond to splints, injections, or therapy.
  • Significant difficulty with daily tasks (gripping, pinching).
  • X-ray evidence of advanced joint damage (cartilage loss, bone spurs).
  • Younger or active patients seeking to maintain function.

The CMC Arthroplasty Procedure & Recovery Timeline

  • Surgery: Performed as an outpatient (day-case) procedure under regional or general anaesthesia.
  • Initial Recovery (Weeks 1-2): The thumb is immobilised in a cast in week one, then replaced with a removable splint in week 2 for 1-2 more weeks.
  • Rehabilitation (Weeks 2-6): Patients begin hand therapy to regain motion and strength. Full recovery typically takes 4 to 6 weeks.

Frequently Asked Questions About Thumb Joint Replacement

  • How long does the implant last? Modern implants are durable, but longevity varies. They can last for many years, though there is a potential for wear or loosening over decades, which may require revision surgery.
  • Can I drive after surgery? No, immediately after surgery, especially the thumb is in a cast and whilst taking narcotic pain medication. Driving can resume once you have a firm grip and are off strong pain medications, typically around 4-6 weeks.
  • Can I regain full function? Yes, most patients regain excellent strength and function. Success depends on dedication to therapy and lifestyle adjustments like adequate rest, a healthy diet, and avoiding smoking.
  • Can I travel? Yes, but carrying a card or copy of an X-ray indicating the implant is advisable to facilitate security screening.

CMC Arthroplasty  Potential Risks and Complications

As with any surgery, risks include infection, blood clots, nerve injury, and anaesthesia complications. Specific risks to CMC arthroplasty include implant dislocation, loosening, or failure, which might necessitate further surgery.

Conclusion

CMC joint arthroplasty is an effective solution for debilitating thumb-base arthritis, offering a balance of pain relief and preserved mobility. A discussion with a hand surgeon is essential to determine if this is the right option for your individual condition and goals.

Pertinent References

  1. Spawn, E. D., & Awan, H. M. (2021).Current Concepts in the Management of Thumb Carpometacarpal Osteoarthritis. Journal of the American Academy of Orthopaedic Surgeons. (A comprehensive review of all treatment options, including surgical techniques).
  2. Klausmeyer, M. A., & Mudgal, C. (2013).Arthroplasty of the Thumb Carpometacarpal Joint. Seminars in Plastic Surgery. (Details the surgical technique and outcomes of various arthroplasty methods).
  3. Berger, A. J., & Momeni, A. (2014).Thumb carpometacarpal joint arthroplasty: a systematic review. Journal of Hand Surgery (European Volume). (A systematic review comparing the outcomes of fusion and replacement surgeries).
  4. Matullo, K. S., et al. (2007).Carpometacarpal joint arthritis of the thumb. The Journal of the American Society for Surgery of the Hand. (A foundational article outlining the staging of arthritis and corresponding treatment indications).
  5. Boeckstyns, M. E., & Merser, S. (2017).New implant designs for arthroplasty in the thumb CMC joint. Journal of Hand Surgery (European Volume). (Discusses the evolution and outcomes of modern prosthetic implants).