CMC Arthritis: Surgical Procedures, Recovery, and Risks

What is the name of the surgery for CMC arthritis?

The most common surgical procedure for carpometacarpal (CMC) joint arthritis, particularly at the base of the thumb, is trapeziectomy, often combined with ligament reconstruction and tendon interposition (LRTI). However, other surgical options like arthrodesis (fusion) or arthroplasty (joint replacement) may also be considered depending on the individual case.

Understanding CMC Arthritis

The carpometacarpal (CMC) joint, also known as the basal joint, is located at the base of the thumb where the metacarpal bone of the thumb meets the trapezium bone of the wrist. This joint is crucial for the thumb's wide range of motion, allowing for pinching, gripping, and opposition (touching the thumb to the fingertips). Due to its high mobility and frequent use, the CMC joint is a common site for osteoarthritis, a degenerative joint disease characterized by the breakdown of cartilage, leading to pain, stiffness, weakness, and decreased function.

When is Surgery Considered for CMC Arthritis?

Surgical intervention for CMC arthritis is typically considered when conservative, non-surgical treatments have failed to provide adequate relief from pain and functional limitations. Conservative approaches usually include:

• Rest and activity modification
• Over-the-counter pain relievers (NSAIDs)
• Splinting or bracing to support the joint
• Corticosteroid injections into the joint
• Physical or occupational therapy to improve strength and mobility

If these methods do not alleviate symptoms or if the arthritis significantly impacts daily activities and quality of life, surgery may be recommended. The decision for surgery is highly individualized, based on the severity of arthritis, the patient's age, activity level, and overall health.

Primary Surgical Procedures for CMC Arthritis

Several surgical techniques are employed to address CMC arthritis, each with its own indications and considerations.

• Trapeziectomy: This is the most common surgical procedure for CMC arthritis. It involves the complete surgical removal of the trapezium bone, which is one of the carpal bones that forms the CMC joint. By removing the arthritic bone, the source of pain from bone-on-bone friction is eliminated. While effective in relieving pain, removing the trapezium can create a space that might lead to the thumb metacarpal sinking into the wrist, potentially causing instability or impingement.

• Ligament Reconstruction and Tendon Interposition (LRTI): Often performed in conjunction with a trapeziectomy, LRTI aims to stabilize the thumb metacarpal and prevent it from collapsing into the space left by the removed trapezium. During this procedure, a portion of a local tendon (commonly the flexor carpi radialis or palmaris longus tendon) is harvested. This tendon piece is then used to reconstruct the torn or weakened ligaments that support the thumb, and a portion of it is rolled up and placed into the space where the trapezium once was, acting as a "spacer" or cushion to prevent bone-on-bone contact and maintain joint alignment.

• Arthrodesis (Fusion): Arthrodesis involves surgically fusing the thumb metacarpal to the trapezium bone, effectively eliminating joint motion. This procedure provides excellent pain relief and stability, making it suitable for younger, active individuals who require strong pinch and grip strength, such as manual laborers. However, the trade-off is a permanent loss of motion at the CMC joint, which can affect the thumb's ability to fully oppose and perform certain fine motor tasks.

• Arthroplasty (Joint Replacement): Similar to hip or knee replacements, CMC joint arthroplasty involves replacing the damaged joint surfaces with an artificial implant. These implants can be made of various materials, including silicone, pyrocarbon, or metal. While theoretically restoring motion and relieving pain, long-term outcomes for CMC joint replacements can vary, and they are generally less common than trapeziectomy with LRTI due to potential issues like loosening, dislocation, or wear of the implant over time.

Post-Surgical Rehabilitation and Recovery

Regardless of the specific surgical technique, a structured rehabilitation program is crucial for optimal recovery and restoration of hand function.

• Immobilization: Immediately after surgery, the hand and thumb are typically immobilized in a cast or splint for several weeks to protect the healing tissues.
• Physical/Occupational Therapy: Once the initial healing phase is complete, a therapist will guide the patient through exercises to regain range of motion, strength, and dexterity. This may include gentle passive and active exercises, scar management, and techniques to improve pinch and grip strength.
• Gradual Return to Activity: Recovery can take several months, with a gradual return to light activities followed by more strenuous tasks. Full recovery, including maximal strength and function, may take up to six months to a year.

Potential Risks and Considerations

As with any surgical procedure, CMC arthritis surgery carries potential risks, including:

• Infection
• Bleeding
• Nerve injury (leading to numbness or weakness)
• Stiffness or limited range of motion
• Persistent pain
• Complex Regional Pain Syndrome (CRPS)
• Complications specific to the chosen procedure (e.g., implant loosening in arthroplasty, non-union in fusion, continued instability after trapeziectomy)

A thorough discussion with your orthopedic surgeon about the risks and benefits of each procedure is essential to determine the most appropriate surgical plan for your individual needs.

Conclusion

While there isn't a single "name" for CMC arthritis surgery, trapeziectomy, often augmented with ligament reconstruction and tendon interposition (LRTI), stands out as the most widely performed and successful procedure for alleviating pain and restoring function. Other options like arthrodesis or arthroplasty offer alternatives for specific patient profiles. The ultimate goal of any surgical intervention is to reduce pain, improve stability, and enhance the functional capacity of the thumb, allowing individuals to regain independence in daily activities.