Thumb Arthritis and Joint Replacement
in Rockhampton

What is going on

Basal thumb arthritis — osteoarthritis of the joint between the trapezium and the first metacarpal — is one of the most common forms of osteoarthritis in the hand. Patients describe deep aching pain at the base of the thumb that worsens with pinch and grip — turning a key, opening a jar, writing for any length of time. The thumb base looks squared off as the metacarpal subluxes radially. The condition is more common in women, in middle age and beyond, and runs in families. Splints, activity modification and intra-articular corticosteroid injections settle a meaningful fraction of cases; surgery is offered when the pain and functional loss have become disabling despite a thorough non-operative trial.

Not sure if this is the right diagnosis? The thumb pain hub triages the differential by anatomical location.

What the operation involves

Two main operations are offered. **Trapeziectomy with suspensionplasty / LRTI** — the trapezium is removed and a strip of the flexor carpi radialis tendon is woven through the metacarpal base to suspend it. **Joint replacement** — a dual-mobility prosthesis (similar to a small hip replacement) is implanted into the trapezium and metacarpal base. Both are performed under regional or general anaesthesia as a day case, take around 60 to 90 minutes, and are followed by a thumb spica splint or cast for the first two to four weeks. The choice between trapeziectomy and replacement depends on bone quality, activity level, and patient preference — the consult sets out the trade-offs. Full clinical detail is on the education page and the basal thumb arthritis education page.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the thumb joint replacement education page or the hand surgery overview.

How this case is handled

The practice's approach to basal thumb arthritis emphasises a thorough non-operative trial first — splinting, activity modification, hand-therapy guidance, and a corticosteroid injection where appropriate. For patients who progress to surgery, the trapeziectomy / LRTI vs dual-mobility joint replacement decision is made jointly with the patient, with both options' trade-offs explained in detail. Hand therapy with Ruby Doolan at Extend Rehabilitation is built into the post-operative pathway from day one. Where the contralateral thumb is also symptomatic, surgery is staged — never both thumbs at the same operation.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 46324 Carpometacarpal joint arthroplasty (joint replacement)

Billed for dual-mobility or pyrocarbon thumb-base joint replacement

Patient questions we hear most

• Should I have a trapeziectomy or a joint replacement?

  Both operations reliably relieve pain — published outcomes give similar pain scores at one year. The differences are in the recovery curve and the trade-offs over time. Trapeziectomy has a longer track record (it has been done for over 70 years) and is forgiving of bone loss; the recovery is slower and pinch strength returns gradually over six to nine months. Joint replacement returns pinch grip faster, often by 6–8 weeks, and tends to feel more 'normal' to patients who pinch a lot — for instance manual workers, musicians and tradespeople. The replacement has a small risk of needing revision over decades; the trapeziectomy does not. The choice is individual and is worked through at the consult with reference to bone quality on imaging, activity demands, and what a patient wants prioritised — speed of recovery vs absolute durability.

• How long does a thumb replacement last?

  Modern thumb base joint replacements — dual-mobility and pyrocarbon implants — have improved markedly over earlier silicone designs, and the majority are still functioning well at ten years. A thumb replacement can wear or loosen over decades, and a revision is more involved than the first operation, which is why implant choice and activity level are discussed carefully before surgery. Trapeziectomy, the main alternative, removes the worn bone rather than replacing the joint and so has no implant to wear out — the durability trade-off between the two is a central part of the consult.

• Do I need any tests before surgery?

  Plain X-rays of the thumb base in standard views are required to confirm the diagnosis and stage the arthritis (Eaton-Littler grade I–IV). Where the picture is mixed — or if the surgeon is considering a joint replacement — a CT scan may be requested to assess bone quality in the trapezium. Pre-operative blood tests and an anaesthetic review are arranged ahead of theatre. Patients on blood thinners are managed in coordination with the prescribing GP or specialist.

• How long is the recovery?

  Recovery is staged. The thumb is in a splint or cast for the first two to four weeks. Hand therapy starts at the first dressing change with gentle range-of-motion and gradual return of pinch. Light office work resumes at one to two weeks; manual or pinch-heavy work is held off until three to four months. Final outcomes are usually settled by six to nine months. Joint replacement tends to give earlier pinch grip; trapeziectomy continues to improve over the first year.

• What's the difference between this and a thumb fusion?

  Thumb base fusion (CMC arthrodesis) eliminates the joint by fusing the trapezium and metacarpal together — pain relief is reliable, but the thumb loses circumduction (the ability to oppose to the little finger). Fusion is reserved for younger, very high-demand patients (particularly tradespeople doing heavy gripping) or as a salvage after a failed reconstruction. Most patients are better served by trapeziectomy or joint replacement, both of which preserve thumb motion. Fusion is rarely performed at the practice as a primary operation for basal thumb arthritis.

• Will I be able to pinch and grip normally?

  Pinch and grip return progressively. Most patients regain enough function for daily activities — buttons, jars, cooking, writing — by two to three months. Heavy pinch (turning a key, opening a tight lid) and heavy grip (gripping tools, pulling weeds) take longer. By six to nine months the thumb feels like a thumb again. Pinch strength typically returns to 80–90% of the contralateral side after either operation, sometimes more after joint replacement.

• How much does thumb joint replacement cost? What does Medicare cover?

  The operation is performed under regional or general anaesthesia at Mater Private Hospital Rockhampton, so a separate anaesthetist gap applies on top of the surgeon and hospital fees. The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. Joint replacement implants are typically covered by private health funds (a no-gap arrangement is in place for most major funds); patients without private cover can be quoted self-funded. Surgery does not proceed without itemised written informed financial consent — see the fees page for the full process.

• Do I need hand therapy after surgery?

  Yes — hand therapy is integral. Every patient sees Ruby Doolan at Extend Rehabilitation (in the same suite as Dr Hirpara's rooms) for the first dressing change, splint adjustment, scar management, and a structured programme of pinch and range-of-motion exercises. Therapy typically runs weekly for the first six to eight weeks, then tapers. Therapy is built into the post-operative pathway and the surgical quote covers the hand-therapy referral.

More general questions about appointments, fees and the practice on the FAQ page.