Thumb CMC Arthroplasty

Thumb CMC arthroplasty removes the trapezium bone at the base of the thumb and rebuilds the joint using a tendon graft or implant. It's the most common surgery for basal joint arthritis — the wear-and-tear arthritis at the thumb base that causes a deep aching pain with pinching and gripping. The condition is more common in women and tends to develop after age 50.

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Thumb CMC Arthroplasty surgery - orthopaedic procedure overview and what to expect

Who Needs Thumb CMC Arthroplasty?

Surgery is appropriate when thumb base pain limits daily tasks — opening jars, turning keys, writing — despite at least 6 months of non-operative care: splinting, activity modification, and cortisone injections. Documented arthritis on X-ray along with meaningful functional loss is the typical threshold.

What to Expect

X-rays to grade arthritis severity (Eaton classification stage I-IV)

Surgery takes 45-90 minutes under regional or general anesthesia

The trapezium bone is removed through a 1-2 inch incision at the thumb base

A tendon from the forearm is rolled into a scaffold to fill the space (ligament reconstruction with tendon interposition — LRTI)

Thumb cast or splint for 4-6 weeks

Outpatient procedure — home same day

Recovery Timeline

Weeks 1-6

Thumb in a cast or splint. No pinching or gripping with that hand. Finger exercises help prevent stiffness.

Weeks 6-10

Splint comes off. Occupational therapy starts rebuilding range of motion and pinch strength.

Months 3-4

Pinch and grip strength returning. Most daily tasks possible again.

Months 4-6

Progressive strengthening. Return to most work and recreational activity.

Months 6-12

Maximum strength and function reached. Most patients have significant pain relief and a much improved grip.

Risks & Complications

Thumb shortening (mild, usually not functionally significant)
Weakness lasting up to 12 months
Scar tenderness
Infection (less than 1%)
De Quervain's tendinitis at the surgical site
Incomplete pain relief (uncommon — satisfaction rates above 90%)

Frequently Asked Questions

Is thumb CMC arthroplasty worth it?

Satisfaction rates run above 90% in most published series — among the highest for any hand surgery. Pain relief is reliable and lasts. The trade-off is a long recovery: full strength takes 6-12 months. Most patients feel it was worth it once they're through.

How long is recovery from thumb CMC surgery?

The cast or splint comes off at 4-6 weeks, then occupational therapy slowly rebuilds pinch and grip over the following months. Most patients have useful function back by 3-4 months and reach their final strength at 6-12 months. That's longer than most hand surgeries, and worth knowing upfront.

What is the LRTI procedure?

LRTI uses a small tendon from the forearm, rolled up and packed into the space left after the trapezium is removed. It acts as a biological cushion. It's the most widely used technique in the US, with a track record going back decades.

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Estimated Cost

$8,000 - $20,000 (before insurance). Widely covered by insurance with documented failed conservative treatment.

Full cost breakdown

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This information is for educational purposes only. Costs are estimates and vary by location, surgeon, and insurance. Always consult a qualified healthcare provider.