The two most commonly affected body joints are the knee and the hip. Quite often the base of the thumb is also affected resulting in pain, stiffness and difficulty in daily movements.

“Arthritis of the base of the thumb usually affects women over the age of 40, but men are not excluded. There appears to be a genetic predisposition (inheritance) to the development of this arthritis while injuries, overuse and rheumatic diseases can make it worse.

In the early stages there is pain at the base of the thumb, especially when gripping objects with force such as opening a jar and turning the key in the lock. The pain then worsens and extends to other daily movements. There is often swelling at the base of the thumb which can appear to be out of place,” explains o Mr. Nikolaos A. Darlis MD, PhD, Director of Upper Extremity Orthopedic Surgery and Reconstructive Microsurgery at Metropolitan Hospital, former President of the Hellenic Society of Reconstructive Microsurgery (2021) and continues:

“Treatment depends on the stage of the arthritis. In the initial stages, the use of anti-inflammatory drugs or glucosamine or chondroitin preparations can help the symptoms. Although there are no serious scientific indications that these drugs stop or even slow down the progression of the condition, which however differs from person to person. In the early stages, splints, physical therapy, cortisone or hyaluronic acid injections, hot or cold packs can also be used.

When the arthritis is advanced and does not respond to conservative measures, then surgery is indicated. Staging is mainly done with appropriate plain radiographs. Surgical options available for moderate arthritis include:

• Arthroscopic cleaning of the joint with 2-3 mm arthroscopic cameras and resection of part of the arthritic bone, which can relieve pain.
• Another option is osteotomy to change the orientation of the joint so that it wears more naturally and
• Tendon transports that stabilize the joint

The above solutions are suitable for a limited number of patients with moderate arthritis. For advanced arthritis the most widespread and effective operation is to remove the worn bone and replace it using the patient’s own tendon (tendon interposition arthroplasty).

This solution preserves the length and functionality of the thumb without pain, but has the disadvantage of requiring prolonged immobilization and the recovery time is two to three months. Also, there is the possibility of arthrodesis where worn bones are joined together. With this solution, the mobility is somewhat limited but the pain disappears and the strength of the thumb is preserved, so it is more suitable for heavy manual workers. The disadvantage of this method is the prolonged recovery time,” he explains.

“In the last 20 years there have been many attempts to develop total arthroplasties of the base of the thumb, i.e. metal and plastic implants just like those used in the knee and hip joints. Due to the very small size of the joint, the first attempts faced significant problems. However, today we are happy to have newer implants with very good features, which can provide pain-free thumb with full functionality for many years as for hip and knee. And precisely because the joint of the base of the thumb is very small, obviously there are no problems of the gravity of the operating room and the loss of blood that exist in the corresponding arthroplasties of large joints (knee and hip).

The main advantage of the new generation of total thumb arthroplasties is the quick recovery. The thumb remains in a simple bandage (no splint) for three weeks, and after the third week there is full and painless movement. These advantages make this option particularly attractive for people of a relatively younger age and with high functional requirements.

We should, however, keep in mind that there are conditions for this surgery to be performed successfully and safely, and for this reason not all patients with arthritis of the base of the thumb are ideal candidates. Also, this is a technically demanding surgery that should only be done by hand surgeons as we are talking about implants in the order of millimeters.

In conclusion, each patient should be assessed carefully and individually and, if the total arthroplasty of the base of the thumb is suitable, it can cure the problem with minimal intervention in his daily life” concludes Mr. Darlis.

*The new generation total thumb arthroplasty (with implants corresponding to the newer ones used in the hip and knee) is now practiced at the Metropolitan Hospital to treat arthritis of the base of the thumb with minimal recovery time.
In the Department of Upper Extremity Orthopedic Surgery and Reconstructive Microsurgery at Metropolitan Hospital there is accumulated experience in all methods of thumb arthritis treatment and the patient can be advised on the best, individualized solution that is suitable for him.