Update on treatment options for thumb arthritis

Background: Arthroplasty of the thumb requires the same level of clinical rigor as major joint replacement, necessitating precise case management and a documented decision-making process. Patients often present with failed conservative management using over-the-counter orthotics that do not address specific thumb column deformities or carpometacarpal (CMC) subluxation.

Objective: This article outlines a systematic approach to the clinical assessment and surgical management of basal thumb osteoarthritis, categorized by anatomical location and patient-specific functional requirements.

Key Points: Initial management should prioritize custom-made splints and occupational therapy. Surgical intervention is considered if pain persists after conservative trials, with the choice of procedure dictated by the specific site of degeneration: carpo-metacarpal (CMC), scapho-trapezio-trapezoidal (STT), or peri-trapezial (PT) arthritis. For STT arthritis, distal scaphoid resurfacing is presented as an alternative to arthrodesis. CMC arthritis is primarily managed with jointed prostheses, though dual-mobility and single-mobility designs show varying long-term survivorship. CMC arthrodesis remains a viable option for high-demand manual laborers. PT arthritis may be treated via trapeziectomy with ligamentoplasty or pyrocarbon interposition. Patient occupation and proximity to retirement are critical factors in determining the appropriateness of prosthetic versus palliative or arthrodesic procedures.

Conclusion: Successful outcomes in thumb surgery depend on a comprehensive preoperative assessment that aligns the surgical technique with the patient’s age, occupational demands, and the specific radiographic grade of osteoarthritis. Accurate documentation of these clinical discussions is essential for informed consent and longitudinal care.