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Carpometacarpal (CMC) arthroplasty reconstructs the thumb joint to address pain and inflammation, usually in a patient with arthritis. Older adults typically need this surgery as the wear and tear on the joint over the course of their lives eventually limits mobility and causes pain. Younger patients may need surgical treatment if they have juvenile arthritis or a history of thumb injuries, a common problem for athletes in impact sports like basketball. It is often performed by a hand specialist or surgeon who specializes in joint reconstruction, as it requires a detailed knowledge of anatomy.
Also called the basal joint, the carpometacarpal joint is located at the point where the thumb meets the hand. It needs to be extremely mobile to allow for a full range of flexibility so the thumb can be used in a variety of tasks. This can make it more susceptible to injury. People can develop arthritis over time which causes recurrent inflammation, leading to buildups of tissue around the basal joint that cause symptoms like pain, soreness, and stiffness. If conservative treatments are not effective for management of the patient's case, carpometacarpal arthroplasty may be recommended.
Before a carpometacarpal arthroplasty, a surgeon can physically examine the hand and review x-rays to learn more about the specific nature of the damage. This allows the surgeon to develop a plan that may include shaving off excess bone, moving tendons or ligaments, or implanting materials in the thumb to stabilize the joint. The best option can depend not just on the case, but the patient’s medical history and the level of activity the patient wants to resume after surgery.
Anesthesia is required for carpometacarpal arthroplasty to limit pain for the patient and allow the surgeon to work safely. Some patients may need to be placed under general anesthesia, while others may be able to receive regional anesthesia and sedation while the surgeon works. The length of time spent in the operating room can depend on the nature of the repairs and any complications that arise during surgery. Potential complications can include nerve injuries, infection, and adverse reactions to anesthesia.
After carpometacarpal arthroplasty, patients will need to wear a cast to immobilize the joint while it heals. In checkups, analysis of x-rays can confirm that the joint is healing and check to make sure it is aligned properly. Once the cast is removed, the patient may need to attend physical therapy for several weeks or months to build strength and joint mobility. This includes exercises to do at home, which are an important component of the carpometacarpal arthroplasty recovery plan to help patients regain full strength more quickly.