The carpometacarpal (CMC) joint at the base of the thumb powers essential tasks—pinching, twisting, gripping, and precise maneuvers like buttoning a shirt. Because it manages high loads and wide ranges of motion, it’s among the firsthand joints to show wear over time.
As protective cartilage thins, bone-on-bone contact leads to symptoms of arthritis including aching at the thumb base, swelling, and reduced dexterity. Everyday activities—opening jars, turning keys, using scissors, or prolonged typing—can become painful and frustrating.
Many people achieve relief with non-surgical remedies for thumb joint pain: activity modification, splinting, thumb arthritis physical therapy, anti-inflammatories, or cortisone injections. Soft tissue reconstructions such as Ligament Reconstruction and Tendon Interposition (LRTI) thumb surgery is considered when pain persists or function declines despite these measures.
Modern thumb base arthritis treatment options have recently expanded upon the time-tested “bone removal and tendon cushion” procedure to include precision total joint replacements designed specifically for the thumb. While traditional procedures remain a regional standard, specialized dual-mobility arthroplasty is available at select centers—Proliance is one of the few in the state offering this next-generation solution.
The Time-Tested Standard: LRTI
Introduced in the 1970s and widely adopted in the 1980s, LRTI thumb surgery has been the benchmark for advanced thumb CMC arthritis for decades.
The Procedure
During LRTI, the surgeon removes the trapezium—the small arthritic bone at the base of the thumb—to eliminate painful bone-on-bone contact. A nearby tendon, commonly the Flexor Carpi Radialis although other options are available, is then repurposed: a strip is used to reconstruct and stabilize the thumb, while the remaining tendon is fashioned into a soft “anchovy” cushion that supports the joint space and helps maintain comfort and function.
Expected Results and Trade-Offs
- Reliable remedies for thumb joint pain: LRTI delivers durable relief, and with the trapezium removed, arthritis in that joint does not recur.
- Long track record: More than 40 years of data support its safety, using your own tissue and avoiding implant-related wear or hardware complications.
- Recovery timeline: Most patients spend 4–6 weeks in a splint or cast (sometimes with temporary pins) before starting thumb arthritis physical therapy. A graduated return to regular activities normally starts around 12 weeks. Strength typically improves over 6–12 months.
- Thumb height changes: Some subsidence can occur as tissues settle, slightly shortening the thumb and can reduce peak pinch strength, though daily function remains strong for most.
- Donor site considerations: Using a wrist tendon can cause localized soreness or temporary nerve irritation that generally improves with healing.
Emerging Surgical Option: TOUCH CMC Total Joint Replacement
Refined in Europe with strong results over more than a decade, dual-mobility trapeziometacarpal implants apply proven joint replacement principles—smooth motion and stability—to the small but powerful thumb CMC joint. With U.S. FDA clearance, adoption of this remedy for thumb joint pain is growing in the United States.
The Procedure
TOUCH CMC arthroplasty uses a miniature ball-and-socket design—conceptually similar to a hip replacement—to restore controlled, smooth motion while preserving the native trapezium. Small titanium and polyethylene components are anchored within the bone, and a dual-mobility liner enhances stability to help reduce the risk of dislocation, supporting earlier return to comfortable daily use.
Expected Results and Trade-Offs
- Faster early recovery: Many patients move from a soft dressing to light daily activities within 1–2 weeks, with less rigid immobilization and quicker return to personal care and desk work. Released to regular activities at 6 weeks.
- Preserved anatomy and strength: Maintaining thumb length and alignment can support stronger early pinch and grip—useful for opening containers and handling tools.
- Stability by design: Dual-mobility features enhance stability compared to older implant generations.
- Longevity and revision: As with any implant, there is a long-term risk of wear or loosening. If needed, revision options—including conversion to an LRTI-type procedure—remain available.
- Candidate requirements: Adequate bone quality and anatomy are essential. Severe collapse or arthritis in adjacent joints may favor alternative thumb arthritis treatments.
- Growing U.S. data: European outcomes are robust, and American early- and mid-term results are encouraging, with ongoing studies expanding long-term insights.
Which Procedure Is Best for You?
Both procedures provide excellent results, reducing pain and improving function. LRTI is often ideal for those who prefer a time-tested, implant-free solution and can commit to a longer recovery for durable relief. Conversely, the TOUCH CMC joint replacement may appeal to individuals prioritizing a faster return to daily activities and preserved thumb strength, provided they have good bone quality and understand that the implant may require future maintenance. The best choice is a personal decision based on your specific goals, lifestyle, and work demands.
Expert Care at Proliance
Our hand and upper extremity team continually evaluates advances to offer the most effective, evidence-based treatments. Traditional procedures remain a cornerstone of thumb arthritis treatment, and specialized options like the TOUCH CMC total joint replacement reflect exciting progress. Because dual-mobility prostheses require dedicated training and precise technique, they are currently offered by a limited number of specialists in the state—including Dr. Todd Guyette at Proliance—so you can feel confident you’re exploring every modern option available.
