Surgical Treatments for Thumb CMC Arthritis

Thumb arthritis is a common cause of hand pain.. Denis Kartavenko / Getty Images

Arthritis of the CMC joint of the thumb, also called basilar arthritis, is a condition that is very common.  Because of the shape of the joint at the base of our thumbs, this area is especially prone to developing arthritis symptoms.  Fortunately, most people find relief from arthritis of the thumb with simple treatments, such as a supportive thumb abduction brace.  However, there are situations where people don't find adequate relief, and ultimately decide to have surgery.

The confusing part of surgery, is that there are dozens of different procedures that surgeons use for treatment of arthritis of the thumb.  Some are more common than others, but many different types, and with many different variations, exist for treatment of thumb arthritis.  These are some of the common types of thumb arthritis surgery:

  • Arthroplasty: The most common surgical treatment for basilar arthritis of the thumb is called an arthroplasty.  Arthroplasty is a word for replacement of a joint.  There are many variations of this procedure where your surgeon will remove a small bone (the trapezium) at the base of the thumb.  The arthritic joint is formed by the trapezium and long bone at the base of the thumb (the metacarpal).  Removal of the trapezium creates a space where the joint used to be. 

    Filling this void after resection of the trapezium is a subject of great controversy.  Some surgeons will leave a space there, and allow scar tissue to fill the void (resection arthroplasty).  Other surgeons will fill the void with a segment of tendon (called an interposition arthroplasty).  Other surgeons will reconstruct the ligaments to support the base of the thumb (suspension arthroplasty).  Rarely, surgeons may use artificial material to create a new joint.  Knowing which option is best, as orthopedic surgeons love to debate the merits of their preferred technique--none of these has clearly been shown to be superior to all of the others.

  • Osteotomy:  An osteotomy is a surgical procedure to realign the bones.  Often, basilar arthritis is the result of overloading of one part of the bone at the base of the thumb.  By breaking the bone and realigning it, the forces are shifted from the damaged part of the joint to the healthier part of the joint.  Osteotomy is a good option for more active patients who only have damage to a portion of the joint at the base of the thumb.
  • Fusion: A fusion is a surgery that stimulates bone to grow across a joint so that the joint is permanently stiff.  Fusion surgery is generally reserved for young, active laborers who would not find the arthroplasty procedures sturdy enough to support their ability to return to work.  The downside of a fusion is loss of mobility of the joint, but typically normal strength is maintained.

Bottom Line: What Is Best

There is no best option, and if one specific option had been shown to be better, it would be used more frequently.  The reality is, that while some surgeons feel strongly that one option is better, this has not been proven in medical studies. 

What I can tell you is this: most surgeons are more comfortable with one technique, and your surgeon is almost always going to recommend their preferred technique.  Asking a surgeon to perform a surgical procedure they perform less frequently is not a good idea.


Barron OA, Glickel SZ, Eaton RG. "Basal Joint Arthritis of the Thumb" J. Am. Acad. Ortho. Surg., September/October 2000; 8: 314 - 323.

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