Jeremy Field - Consultant Orthopaedic and Hand Surgeon

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There are various options for surgery:

1. Base of thumb osteotomy - a simple operation where a wedge of bone is taken out of the base of the thumb metacarpal which alters the angulation of the joint and is supposed to help the pain. There have been no randomised controlled tests to determine the effectiveness of this option but in Mr Field's practice patients have not done very well following this procedure and have needed further surgery within a couple of years.

2. CMCJ arthrodesis - this involves fusing the joint at the base of the thumb. It is a good operation for young manual working gentlemen. Arthritis does not often occur in this sort of patient and so it is a rare procedure to be performed. It is successful but like with any form of arthrodesis there is a chance of the arthrodesis (fusion of the joint) failing. The failure of fusion of this joint is quite high 10 - 20%.

3. CMCJ arthroplasty - the word arthroplasty means widening of the joint and there are various forms of arthroplasty.

a) Excision arthroplasty in the form of a Trapeziectomy where the trapezium is removed and there may or may not be a suspension procedure using a ligament to try and suspend the thumb metacarpal so that it doesn't descend down into the space that is left when the trapezium is removed.

b) Total arthroplasty - This is where a mini hip replacement is put into the thumb i.e. there is a component that goes up the marrow cavity of the thumb metacarpal and there is a little cup that is placed into the trapezium.