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Hemi-arthroplasty of the thumb Total thumb arthritis can be treated with a Trapeziectomy (excision arthroplasty0 or a hemi-arthroplasty which involves replacing half the joint. The joint replacement is made with pyro carbon which is made of a hard black material used for many years in small joint prosthesis of the hand and also prosthetic heart valves. ANAESTHETIC General or regional anaesthetic. OPERATIVE PROCEDURE Longitudinal incision made over the dorsum (back) of the thumb. Skin flaps raised and branches of the radial nerve identified and avoided. Radial artery identified and sling passed round this. This is retracted to avoid damage. A longitudinal incision made in the joint capsule and a jig (form of template) is passed up the marrow cavity of the thumb metacarpal and the metacarpal is cut according to the line of the jig. The metacarpal is then reamed using successive reamers of different sizes up to the correct size (the one that fits). A burr (circular saw) is then used to ream out a circular hole in the trapezium which has to be the same size as the head of the prosthesis that is going to be used. The prosthesis is then inserted and assessed for stability. The capsule is then closed. The tendons over the back of the thumb are then joined together (tenodesis) in order to reinforce the repair of the capsule. The skin is then closed. POST OPERATIVELY The hand is put in a plaster of Paris half cast with the thumb pulled slightly backwards which increases the stability of the prosthesis. Then hand is elevated overnight and antibiotics are given. Patient is discharged the following day. Seen in outpatients at two weeks when the half cast is removed, the stitches are removed and a further cast is applied for a further 2 weeks with the thumb in a straight position. An X-ray may be taken at this time. COMPLICATIONS
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