The Evidence Supporting Surgery for Thumb Arthitis

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Do we have medical evidence that surgery for thumb arthritis is better than no surgery? Not really. The latest big review of the medical studies contained little information that compared thumb surgery for arthritis to no surgery or other conservative treatments. Instead, seven different thumb surgery procedures were compared against each other. No one procedure was better than another, but there were clear differences in the complications of these thumb surgery techniques. For example, it was surprising to learn that 22% of the patients who underwent trapeziectomy with ligament reconstruction and tendon interposition (taking out a bone at the base of the thumb and inserting a coiled up tendon to cushion the area) had significant complications These included scar tenderness, tendon failure (the coiled up tendon didn’t work as a cushion), and complex regional pain syndrome (a severe disease where the nerves become hypersensitive so that even the slightest movement or normal touch becomes painful). In terms of complications, just removing the trapezoid bone (trapeziectomy) was safer, with only 10% of the patients reporting severe complications. In a search of the national library of medicine, I couldn’t find a study where thumb surgery for arthritis was compared to no surgery, so it’s really unknown if these surgeries work better than not operating or conservative measures like physical therapy, steroid shots, injecting artificial lubricant, platelet rich plasma, or stem cell injections into the damaged thumb joint.

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