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TMC Joint Replacement Surgery

The TMC joint, at the base of the thumb, can be one of the most debilitating places to develop arthritis, but also one of the most common. Activities that can exacerbate TMC arthritis are those that involve forceful grasping, such as opening a jar or forceful pinching such as holding a key. The TMC joint is a saddle joint articulation between the thumb metacarpal bone and the trapezium bone, which allows the thumb great mobility to reach the fingers. The most common cause is wear and tear or degenerative arthritis, which leads to a laxity of the ligaments and the wearing down of the joint cushion of cartilage. Inflammatory arthritis such as Rheumatoid arthritis, as well as fractures, can lead to traumatic arthritis. X-rays are most useful in confirming diagnosis of traumatic arthritis in the joints of the hand. Treatment consists of limiting activities, medication such as ibuprofen and bracing using a thumb spica brace, especially while sleeping at night. A cortisone injection may provide some relief, but this is generally a last resort. If, despite this treatment, a patient has pain at rest or with daily activities, surgery is indicated. A 40-minute outpatient procedure is performed under a general anesthetic. Through two incisions, the trapezium bone that makes up half of the joint is removed. A strong Kevlar suture is pulled through the bones tethering the thumb metacarpal like a noose. The space left behind after the removal of the trapezium bone can be left open or filled with a tendon ball, although the development of the tightrope procedure makes this unnecessary. Post-operative x-rays will show the 2 buttons and the space in the hand. After surgery, the patient is placed in a splint and, after a week, a removable brace. Therapy to regain movement starts at one month after surgery and lasts about two months. Surgery relieves 95 % of the pain and maintains the pre-surgery level of motion. Strength is not increased by surgery, as the joint structurally is not the same as it was before arthritis set in.