If you need to do a lot of heavier activities or manual labour a joint fusion may be recommended. In this procedure the arthritic joint is permanently stiffened up with a metal plate and screws. This is a very good pain relieving procedure but you may find that you are unable to lay your hand flat on the table after this. For this operation it is particularly important that you do not smoke in the period around your surgery as it significantly increases the chances of the bones not joining.
The operation itself takes around an hour and can be done under general anaesthesia – with you asleep; or under regional anaesthesia – with a numb arm. There will be a scar on the back of the thumb, typically around 5-7cm.
After the operation you will be in a cast for six weeks. After the first two weeks you will come back to have your stitches taken out and be put into a new cast. After this you will be given exercises to get the thumb moving. You may be referred for hand therapy if needed. It typically takes 6-12 weeks for the joint to fuse and you will need to avoid heavy activities for this period. The metal plate should stay in for life but can be removed if it is causing problems.
Any surgery carries risk; in addition to the risks of any surgery to the hand; problems that can happen with a thumb base joint replacement are damage to some of the small skin nerves around the scar causing numbness or pain or non-union – this is when the joint fails to fuse and requires further surgery.