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Basal thumb joint replacement

Table of Contents

Arthritis of the thumb carpometacarpal (CMC) joint, also known as thumb basal joint arthritis, is one of the most common areas of arthritis of the hand. Because the thumb contributes approximately 40% of the hand’s function, or 25% of total body function, thumb CMC arthritis is often quite debilitating.

Current treatment and alternatives

Non-operative treatments for osteoarthritis of the hand include anti-inflammatory and analgesic medications, splints, hand therapy and steroid injections, and are universally tried first.

When these treatment options have been exhausted there are surgical options; these include

  • complete joint excision (also called excision arthroplasty or trapeziectomy)
    • with or without tendon interposed in the space left after joint excision
  • fusion of the joint (arthrodesis)
  • basal thumb joint replacement
    • hemiarthroplasty – half the joint
    • total joint replacemement

The TOUCH® CMCJ dual-mobility prosthesis

Mr Alistair Jepson is one of the first surgeons in the United Kingdom to start using this implant, which has been used in Continental Europe since 2014. Whilst thumb replacement implants of differing kinds have been used for many years, these have been prone to early complications of dislocation or late complications of loosening.3c67061c 437f 4865 a721 cb75599010c9

The TOUCH® CMCJ replacement from Keri Medical is a dual-mobility implant (also used in hip replacement) which decreases both these risks. Over 4000 of these implants have now been inserted with excellent early clinical results.

Dual mobility cups have two points of articulation, one between the shell and the polyethylene (external bearing) and one between the polyethylene and the femoral head (internal bearing). Movement occurs at the inner bearing; the outer bearing only moves at extremes of movement.

What the procedure involves

A general or regional anaesthetic is used and a tourniquet is applied to the affected arm to maintain a blood-free operation site. An incision is made over the diseased joint to expose the tendons. The tendons are retracted and the joint is removed with a small oscillating saw. The prosthetic joint is then carefully sized and inserted in place of the original joint (this implant offers 120 possible combinations to fit as close to the patient’s anatomy). The incisions are sutured and a soft splint is applied to the thumb.

Patients go home the same day and range of motion is within the limits of what pain allows. Subsequent to surgery hand therapy and followup with an x-ray is organised.

Resultse108ab57 edd4 4635 98d4 f5ac70a654f4

Mr Alistair Jepson has now done more than ten of these replacements since visiting France in April 2018 to learn the technique. Every patient to date has had significant improvements in both pain and function; furthermore there have been no complications, but each and every patient is being followed up for at least one year with outcome scores and x-rays, in line with good clinical practice when using a new implant.

Case example (47 year old lady 7 weeks post surgery)

TOUCH® CMCJ replacement – June 2018 (posted with patient consent)