Arthritis Surgery

What is arthritis surgery?

Hand and wrist arthritis surgery includes:

  • knuckle replacement – the diseased/damaged knuckle(metacarpophalangeal or proximal interphalangeal) joint(del) is removed and replaced with a new artificial joint.
  • trapeziectomy – the trapezium bone at the base of your thumb and its joint are removed. Some movement is still possible through the unaffected joints that we preserve.
  • wrist fusion – the bones in your wrist are fused with the bones in your hand, which alleviates pain but stops you moving your hand up and down at the wrist.
  • Partial wrist fusion – some of the bones in your wrist are fused to treat arthritis. Some movement is still possible through the unaffected joints that we preserve.
  • wrist joint replacement – this isn’t yet a common procedurebut may be considered in some people with low demands on their wrists.

The most common arthritis surgery is the trapeziectomy for base of thumb arthritis.

Do I need arthritis surgery?

Many people with arthritis in their hands or wrists don’t need surgery. The decision to have this treatment should be made after assessment and discussion with your orthopaedic surgeon. The decision will always be yours to make and you need to carefully consider all of the information you have received including what the expected benefits are, what the risks are and what the alternatives are.

How does arthritis surgery work?

Surgery for arthritis of the hand and wrist aims to relieve pain and restore function. As the pain from arthritis results primarily from bone on bone contact, surgery generally involves stopping the movement of the bones (fusion) or removing the parts of the bone that are rubbing against each other. In some cases, it’s possible to replace the worn joints with new artificial ones.

As an example of arthritis surgery, trapeziectomy is usually performed under a general anaesthetic as a day procedure. It usually takes 30–40 minutes to complete. A tourniquet is placed above the elbow to ensure a bloodless field then an incision is made over the base of the thumb (palm side). The trapezium bone is removed, creating extra space in the joint. A small portion of one of the wrist tendons is then harvested and used to fill the affected space and stabilise the base of the thumb. The skin is sutured closed and a cast is then applied.

What is involved and what to expect after arthritis surgery?

Post-op rehabilitation

You need to keep your hand elevated as much as possible for the first 5 days after surgery. Bending and straightening of the fingers during this time is strongly encouraged. Around 10–14 days after the operation, the wound is reviewed by your hand therapist. At this stage, a thermoplastic splint is fitted, which is worn for 4–6 weeks. Range of motion exercises are usually commenced at this stage under the supervision of the hand therapist.

Most people find that the arthritic pain is gone within 4–8 weeks after surgery. But improvements can continue to be made for 6–12 months after surgery as the thumb strengthens.

Possible complications

More than 95% of patients are happy with the results of the surgery. But complications do occur sometimes.

Some complications specifically related to hand surgery include infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1-2% chance), which is a reaction to surgery that can cause painful or stiff hands.

Complications specific to base of thumb osteoarthritis surgery include failure to completely resolve the symptoms due to arthritis in the adjacent joints. This is rare but may require further surgery. The thumb will be weaker than on the opposite side if this side is unaffected. This will improve with time but may never be fully normal.