Thumb Arthritis Surgery: A Hand Surgeon's Guide to Your Options

Thumb Arthritis

13 May

Is the base of your thumb hurting every time you turn a key, open a jar, or hold a pen? You are not alone — and the way forward is clearer than most patients believe when they first walk into clinic.

Thumb arthritis (also called rhizarthrosis or basal joint arthritis) is the most common form of osteoarthritis in the upper limb. By the age of 65, around one in three women and one in eight men have radiographic evidence of it, although not all will need treatment. When pain and weakness do start to limit daily life, there is now a wide range of options — both non-surgical and surgical.

This guide explains what each treatment actually involves, what the recovery looks like, and how I help patients in my Hertfordshire and London clinics decide between them.

In short: Most cases of thumb arthritis settle with splinting, hand therapy, and occasional injections. When pain becomes constant or significantly weakens grip, the main surgical options are trapeziectomy (the long-standing "gold standard"), suspensionplasty with a synthetic suspension device, and joint replacement using one of the newer implants. Recovery ranges from six weeks to four months depending on the operation chosen, and outcomes are generally very good when the right operation is matched to the right patient.

What is thumb arthritis?

The base of the thumb is a small saddle-shaped joint called the carpometacarpal (CMC) joint or trapeziometacarpal joint. It sits between the trapezium bone of the hand and the long bone of the thumb (the first metacarpal). Its unique shape is what gives the human thumb its extraordinary range of movement — and it is also what makes the joint so prone to wear.

Over time, the cartilage covering the bones of the CMC joint thins. Eventually the surfaces grind directly against each other, the surrounding ligaments stretch, and the joint can drift out of position. The result is pain, weakness, and — in advanced cases — a visible "shifted" appearance at the base of the thumb.

The British Society for Surgery of the Hand has an excellent summary of basal thumb osteoarthritis if you want a deeper anatomical overview.

For more general patient information on the condition itself, mythumb.co.uk maintains a comprehensive reference page on thumb osteoarthritis which complements the surgical focus of this guide.

How do I know if I might need surgery?

Most patients with mild or moderate thumb arthritis do not need surgery. Surgery becomes a serious consideration when one or more of the following is true:

pain is constant rather than activity-related,
grip strength has declined to the point that everyday tasks are difficult,
splints, hand therapy and injections have already been tried without lasting relief,
imaging shows advanced cartilage loss and the symptoms match.

The decision is rarely about the X-ray alone. I see patients with strikingly worn-looking joints who manage perfectly well with a splint, and others with more modest radiographic changes whose pain dominates their day. Treatment should match how the condition is affecting your hand, not the appearance of an image.

Non-surgical options to try first

Before any operation is considered, a stepwise non-surgical approach is appropriate in nearly every case. These are the approaches I usually work through with patients:

A custom or off-the-shelf splint
A short thumb spica splint worn for activities that flare the pain — and sometimes at night — can settle symptoms remarkably well. Some patients use it for a few weeks; others rely on one intermittently for years.

Hand therapy
A specialist hand therapist will teach joint-protection strategies, strengthen the supporting muscles (particularly the first dorsal interosseous), and recommend adaptive equipment. This is one of the most under-used treatments and one of the most effective.

Anti-inflammatory medication
Short courses of NSAIDs — oral or topical — can reduce inflammatory flares. Topical preparations are an excellent first option as systemic side effects are minimal.

Steroid injection
A targeted corticosteroid injection into the CMC joint can give months of relief. The effect varies between patients and the benefit usually diminishes with repeated injections.

Hyaluronic acid or PRP injections
These options have less robust evidence for the thumb CMC joint than for larger joints such as the knee. They may be appropriate in selected cases but should not be presented as a definitive solution.

If a sustained programme of these non-surgical measures still leaves you struggling, the conversation moves naturally toward operative options.

What surgical options exist for thumb arthritis?

There is no single "best" operation for thumb CMC arthritis. There are, instead, several well-validated procedures, each with a slightly different balance of strengths and trade-offs. The main contemporary options are below.

Trapeziectomy
The trapezium bone — the worn one — is removed entirely. The space it leaves usually fills with scar tissue, and the thumb settles into a slightly shortened but pain-free position. It is the operation with the longest track record, and reliably good long-term outcomes.

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI)
A variation of trapeziectomy in which a slip of tendon is used to provide both a sling that suspends the thumb and a soft cushion in the space left behind. The aim is to recreate the stabilising effect of the worn ligaments.

Suspensionplasty using a synthetic suspension device
Instead of borrowing a tendon, a small suture-based device is anchored between two bones to suspend the thumb in position after the trapezium is removed. The recovery is sometimes a little quicker, although the long-term outcomes appear broadly similar to traditional LRTI.

Total joint replacement (CMC arthroplasty)
A small implant — often a dual-mobility design — replaces the worn joint surfaces while preserving bone. Patients tend to recover function more quickly than after trapeziectomy and grip strength can be excellent. Medium-term implant survivorship is good but is not yet as well-established as for hip or knee replacements.

Joint fusion (arthrodesis)
The two bones of the CMC joint are permanently fused, eliminating movement at the joint but also eliminating pain entirely. This is occasionally a good option for younger, manual workers who would put a soft-tissue reconstruction under prohibitive load, but it is now rarely chosen in older patients.

How do I help patients choose between them?

Choosing the right operation depends on several factors — and there is genuine, evidence-based disagreement between surgeons about which approach is "best". In my clinic the conversation usually circles around:

Your age and hand demand
A 75-year-old retired teacher and a 45-year-old builder have very different needs from their thumbs. The right operation is not the same for both.

How quickly you need to get back to function
Patients on tight return-to-work timelines often weigh the recovery time.

The condition of the surrounding joints
If the joint immediately above the CMC (the scaphotrapeziotrapezoid or STT joint) is also worn, some operations are less suitable than others.

Your tolerance of trade-offs
Some patients value a slightly faster recovery; others value the reassurance of decades of follow-up data. Both are legitimate preferences and I try to make the trade-offs explicit before any decision is made.

This is the part of the process where the conversation matters most. Imaging and examination tell us what is possible; you tell us what is right.

My approach at The Schaller Hand & Wrist Clinic

I trained in both orthopaedic and plastic hand surgery through dual fellowships at the Queen Victoria Hospital in East Grinstead and at Chelsea & Westminster Hospital, and I hold the European Diploma of Hand Surgery. That dual background matters here, because thumb arthritis surgery sits exactly at the intersection of bone and soft tissue.

In my practice I offer the full range of operations described above — trapeziectomy, LRTI, suspensionplasty, joint replacement, and fusion in selected cases — at Spire Bushey Hospital in Hertfordshire, Pinehill Hospital in Hitchin, and One Hatfield Hospital. NHS patients are seen at the West Hertfordshire Teaching NHS Trust.

I deliberately do not have a "favourite" operation for thumb arthritis. The operation should be matched to the patient. What I do hold to firmly is a process: a careful diagnosis, a clear conversation about what each option means for your hand.

If you would like a specialist opinion, you can book a consultation directly through the clinic. You are welcome to bring any previous imaging — and any other surgical opinions you have already received for review.

Frequently asked questions

Is thumb arthritis surgery painful?
The surgery itself is performed under either sedation & regional anaesthetic, or general anaesthetic, so you will feel nothing during the operation. Post-operative pain is usually well controlled with simple oral analgesia and rarely requires strong opioids beyond the first 48 hours.

How long will I be in hospital?
Almost all of these operations are performed as day-case procedures. You will arrive in the morning, have the operation, recover for a few hours, and go home the same day with a clear discharge plan.

When can I drive after thumb arthritis surgery?
Most patients return to driving between four and six weeks after surgery, once the thumb is no longer in a rigid splint and they can safely perform an emergency manoeuvre. Confirm with your insurer before you do.

How long does relief from a steroid injection last?
This varies enormously. Some patients have months of meaningful relief; others find the effect lasts only a few weeks. If an injection gives less than three months of relief, it is unlikely to be the long-term answer.

Is joint replacement better than trapeziectomy?
Neither operation is universally better. Joint replacement often gives a quicker recovery and excellent grip strength, while trapeziectomy has the longest track record and remains a good operation in the right patient. The choice should be made together based on your hand, your demands, and your preferences.

Will the arthritis come back after surgery?
The treated joint will not redevelop arthritis — its surfaces have either been removed or replaced. The neighbouring joints can, occasionally, develop wear over time.

Can I have both thumbs done at once?
Bilateral surgery is possible in selected cases but is rarely advisable. The thumb is the most important joint in the hand for daily independence, and having both in a splint at the same time makes the early recovery very difficult.

Will I get full strength back?
The majority of patients regain grip strength that is at least equal to — and often better than — their pre-operative strength once recovery is complete, because their hand is no longer being limited by pain.

In summary

Thumb arthritis is common, treatable, and — when symptoms warrant it — operable, with reliably good outcomes when the right procedure is matched to the right patient.

The conversation that matters is not "which operation is best?" but "which operation is best for you, in your hand, at your stage of life?" That conversation is one I have most weeks in clinic, and one I would be happy to have with you.

If you would like to discuss your thumb pain, book a consultation at The Schaller Hand & Wrist Clinic. Bring any X-rays, MRI reports, or prior opinions — the more complete the picture, the more useful the consultation.

Reviewed and written by Mr Gavin Schaller

FRCS(Tr&Orth), MBBS, BSc(Hons), Dip. Hand Surg. (European)
Consultant Hand & Wrist Surgeon — The Schaller Hand & Wrist Clinic