Table of ContentsView AllTable of ContentsWhat Is It?Its PurposeHow to PrepareWhat to ExpectRecoveryWound CareCopingLifestyle Adjustments

Table of ContentsView All

View All

Table of Contents

What Is It?

Its Purpose

How to Prepare

What to Expect

Recovery

Wound Care

Coping

Lifestyle Adjustments

This article will explain how to prepare for carpometacarpal joint arthroplasty and what to expect.

What Is CMC Joint Arthroplasty?

Joint arthroplasty, or joint replacement surgery, is a surgical procedure in which a portion of damaged and inflamed bone is removed and replaced with metal implants in order to help relieve pain and improve physical functioning for patients witharthritis. While joint arthroplasty is commonly performed in large joints like the hips, knees, and shoulders, joint arthroplasty can also be performed on the thumb joint.

Thumb arthritis, also known as carpometacarpal joint osteoarthritis, occurs at the carpometacarpal (CMC) joint at the base of the thumb, between the metacarpal bone and the trapezium. The force to the joint during gripping, pinching, and grasping movements and the decreased strength of supporting ligaments that occur with aging often cause degeneration of the thumb joint over time. Because the thumb is a very mobile joint, it lacks the stability to withstand repetitive stress and easily wears down over time.

CMC joint arthroplasty typically involves atrapeziectomy, a surgical procedure in which the trapezium bone is removed from the wrist. Once the trapezium is removed, a tendon graft or implant, made from silicone or metal, is then inserted into the missing space to complete the arthroplasty.

Potential Risks

Most people recover well after undergoing CMC joint arthroplasty. Potential risks associated with surgery of the hand and wrist include:

Additional risks associated with joint replacement surgery for the CMC joint of the thumb include:

Consult with your healthcare provider about the possible risks of CMC joint arthroplasty to determine if it is an appropriate option for you given your age, current health status, and medical history.

Purpose of CMC Joint Arthroplasty

CMC joint arthroplasty is commonly performed for arthritis of the thumb that does not improve with conservative treatment options, including:

The surgical team will provide you with more detailed instructions on what you will need to do in the days and hours before your surgery. It is recommended that you stay active, eat a healthy diet, andstop smokingprior to any operation to promote optimal healing and a smooth recovery.

You may need to stop taking certain medications in the days leading up to the surgery to prevent excess bleeding or interaction with anesthesia during the surgery. Always consult with your healthcare provider about all prescriptions, over-the-counter (OTC) medications, and supplements that you are taking for your safety.

CMC joint arthroplasty is often performed as an outpatient surgical procedure at either a hospital or outpatient surgical center. You will likely go home the day of your surgery. You will not be allowed to drive to or from the hospital before or after your surgery, so make arrangements for a friend or family member to provide transportation for you.

On the day of your CMC joint arthroplasty, you will be taken to a pre-op room where you will be asked to change into a gown. You will undergo a brief physical examination and answer questions about your medical history from the surgical team.

You will be taken into the operating room, where you will be given anesthesia. The surgery will either be performed undergeneral anesthesia, in which you are asleep during the operation, or local anesthesia, which involves numbing just your arm so that you do not feel anything during the surgery.

The skin of your hand and thumb will be sterilized with an antiseptic solution to kill bacteria and prevent infection before an incision is made.

During the Surgery

Your surgeon will make an incision along the top of the metacarpal bone of the thumb and use metal retractors to hold the incision open. The radial nerve andradial arterywill carefully be moved out of the way with the retractors to fully expose the underlying bones.

The procedure for your CMC joint arthroplasty will depend on what type of implant is used to replace the trapezium bone. Implants can either be made from metal or silicone, or created from a tendon graft from one of your wrist muscles in a procedure called ligament reconstruction and tendon interposition (LRTI).

For an LRTI procedure, a trapeziectomy is performed first to remove your trapezium bone. The tendon of theflexor carpi radialismuscle of your wrist will also be cut and surgically reattached to the metacarpal bone of the thumb. Part of the cut tendon will be used to reconstruct the palmar oblique ligament that connected the metacarpal bone of the thumb to the trapezium.

The remaining portion of the tendon is then folded eight to 10 times, sewn together like an accordion, and inserted into the space where your trapezium was. As you heal, the tendon will toughen into scar tissue and provide added stability to replace the missing bone from the carpometacarpal joint.

Silicone or Metal Implants

If a tendon graft is not used for your CMC joint arthroplasty, a silicone or metal implant will be used instead. A silicone implant can be inserted into the space where the trapezium was removed following a trapeziectomy, and the joint capsule will be tightly sewn shut.

Silicone implants for CMC joint arthroplasty were primarily used at first but have been associated with the risk of joint dislocation, the formation of cysts (fluid-filled sacs), andsynovitis, or inflammation and swelling of the synovial membrane that lines the CMC joint.

If a metal implant is used, a trapeziectomy will not be performed and the trapezium will stay in place. Instead, a metal implant will be inserted into the metacarpal bone of the thumb that joins the trapezium to form the CMC joint. This procedure is called a saddlehemiarthroplasty.

An incision into the CMC joint capsule will be made and a bone saw will be used to cut perpendicularly into the bone of the thumb’s metacarpal. A 6- to 8-millimeter portion of the bone is then removed. The trapezium may also be reshaped or contoured to improve the shape of the bone and mobility of the joint surface.

A metal implant is then inserted into the space where the portion of the metacarpal bone was removed and hammered into the remaining metacarpal bone before the joint capsule is tightly sewn shut.

After the Surgery

After your CMC joint arthroplasty, you will be brought to a recovery room where your vital signs will be monitored as the effects of the anesthesia begin to wear off. You will typically be able to go home one or two hours after the operation once you are stabilized.

After your surgery, your thumb will be placed in a cast for three to four weeks. When the cast is removed you will be given a plastic splint to wear for four to six weeks. The plastic splint should be worn at all times. However, it can be removed when performing specific exercises to strengthen your thumb. You’re typically weaned off the splint between six weeks and three months after surgery.

You will be referred to either a physical therapist or occupational therapist, who will devise a plan of care and provide you with exercises to restore the range of motion of your thumb and hand. It can take between six and eight weeks to regain full movement in your thumb.

What You Can Do to Manage Pain and SwellingYou may experience pain and discomfort in your thumb after the surgery. Your healthcare provider will prescribe pain medication to help manage your symptoms. Elevating your hand will help decrease swelling, which will result in less pain, increased range of motion, and quicker recovery time.

What You Can Do to Manage Pain and Swelling

You may experience pain and discomfort in your thumb after the surgery. Your healthcare provider will prescribe pain medication to help manage your symptoms. Elevating your hand will help decrease swelling, which will result in less pain, increased range of motion, and quicker recovery time.

If you develop a fever or if the surgical site becomes red, hot, or swollen, contact your healthcare provider immediately because these are signs that you may have an infection.

Coping with Recovery

It is important to follow all instructions from your surgeon and physical therapist or occupational therapist to promote optimal healing and recovery from CMC joint arthroplasty.

Recommendations for optimal recovery include:

It will take some time before you can regain full use of your thumb and hand after the surgery. Make sure that you:

Adaptive toolslike specialized scissors, jar openers, button hooks, key turners, and pen grips can also be used to help you with tasks that require fine motor movement and dexterity of your hands that may be difficult after surgery.

Summary

CMC joint arthroplasty is a surgical procedure used to replace the trapezium bone of the thumb joint with a tendon graft, or a silicone or metal implant to treat carpometacarpal jointosteoarthritisafter conservative treatments fail to relieve symptoms.

A Word From Verywell

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Arthritis Care.Trapeziectomy.Updated December 2019.

Concord Orthopedics.A Patient’s Guide to Arthritis of the Thumb.

Spies CK, Langer M, Hahn P, Müller LP, Unglaub F.The Treatment of Primary Arthritis of the Finger and Thumb Joint.Dtsch Arztebl Int.2018 Apr 20;115(16):269-275. doi: 10.3238/arztebl.2018.0269.

Elfar, JC, Burton, RI.Ligament reconstruction and tendon interposition for thumb basal arthritis.Hand Clin. 2013;29(1):15-25. doi: 10.1016/j.hcl.2012.08.018

Matullo KS, Ilyas A, Thoder JJ.CMC arthroplasty of the thumb: a review.Hand (N Y). 2007;2(4):232-239. doi:10.1007/s11552-007-9068-9

Orbay JL, Poirier S.Saddle Hemiarthroplasty for CMC Osteoarthritis. Operative Techniques in Orthopaedics.2020;30(4):100828. doi.org/10.1016/j.oto.2020.100828.

Hands On Care.CMC Arthroplasty.

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