Touch thumb arthroplasty Info Consent

Q: 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.

Q: 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.

Q: 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.

Q: 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.

Q: 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.

Q: 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.

Q: 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.

X-ray of a thumb after a Touch dual-mobility CMC joint replacement, with the metal stem in the thumb metacarpal and the cup seated in the trapezium. — X-ray after a Touch thumb arthroplasty: a small dual-mobility implant resurfaces the joint between the trapezium and the thumb metacarpal — the joint that wears out in basal thumb arthritis. Kieran Hirpara 4.0

Why this operation has been suggested

Your surgeon has likely suggested this thumb joint replacement because wear-and-tear arthritis in your thumb base has not improved enough with non-surgical treatments. This surgery is typically offered when daily activities become painful and difficult. The goal is to remove the damaged joint surfaces and replace them with a new implant to restore movement.

This procedure aims to give you low pain levels, excellent mobility, and high satisfaction. By replacing the worn joint, you can regain strength and the natural length of your thumb. Your surgeon may recommend this specific approach to ensure the new joint lasts as long as possible while you return to your normal life.

Before the operation

You will need to fast before your surgery and stop certain medications as your surgeon directs. Please arrange a ride home and bring a list of all current medicines. You may need X-rays, blood tests, or an anaesthetic review to ensure you are ready. Your surgeon will use a single cut over your thumb to perform the procedure. You must not drive while wearing the thumb splint for four to six weeks. This splint stops you from gripping the steering wheel safely. You can drive again only once the splint is removed and your surgeon clears you. See Driving after upper-limb surgery for more details.

On the day

You arrive at the hospital and meet your anaesthetist before going to the operating theatre. This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief — the anaesthetist decides on the day based on your individual circumstances. Your surgeon makes a single conventional cut over your thumb to perform the procedure. When you wake up in recovery, you will have a splint on your hand.

You cannot drive while wearing this thumb spica splint. The splint stops you from gripping the steering wheel safely. You must wait until the splint is removed and your surgeon clears you to drive again. See our guide on driving after upper-limb surgery for more details.

What the operation involves

Your surgeon will make a single cut over the base of your thumb. This open approach gives clear access to the joint. Inside, the surgeon removes the worn-out joint surfaces that cause your pain. These damaged areas are then replaced with new metal and plastic parts to create a smooth, moving joint.

To fit the new parts, your surgeon carefully shapes the bone and presses the new cup into place. This step is done with great care to avoid breaking the bone or causing the new part to loosen. Once the new joint is secure, the cut is closed with stitches. You will likely wear a splint on your thumb for four to six weeks to protect the repair while it heals.

You cannot drive while wearing this splint because it stops you from gripping the steering wheel safely. You may only drive once the splint is removed and your surgeon clears you. For more details, see Driving after upper-limb surgery.

After the operation

You will wake up in a recovery ward where your pain is managed gently. Your thumb will be wrapped in a dressing and placed in a splint. You can move your fingers immediately, but you must keep the thumb still. You will likely go home the same day, but someone must stay with you for the first 24 hours. This splint stays on for four to six weeks. Do not drive while the splint is on because you cannot grip the wheel safely. You may drive again once your surgeon removes the splint and clears you.

Recovery

You will feel pain and swelling in your thumb and hand for the first few days. This is normal. Your surgeon will give you a splint or cast to protect the joint. You must wear this device to keep your thumb safe while it heals. Do not drive while the splint is on, as you cannot grip the wheel safely. You can only drive once the splint is removed and your surgeon clears you.

Daily life will feel different at first. You will use your other hand for most tasks like eating or writing. Your physiotherapist will teach you gentle exercises to keep your fingers moving. These movements help reduce stiffness and bring back strength. As the swelling goes down, you will notice your thumb feels more stable. You will gradually start using your hand for light activities without pain.

Your recovery journey is unique to you. Some people feel better faster, while others take more time. Your surgeon and physiotherapist will guide you through every step. They will tell you when it is safe to return to work or sports. Trust the process and listen to your body as you heal.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

You might feel a deep, throbbing pain that does not ease with simple painkillers. This could mean the implant is not sitting correctly or is loosening. If you notice this, call the clinic right away.

Sometimes the joint feels unstable or gives way when you try to use your hand. You might feel a sudden shift or a clicking sensation. Tell your surgeon immediately if this happens so they can check the stability.

In rare cases, the plastic liner inside the joint can break. You may not see this on a standard X-ray, but you might feel a new grinding or catching in your thumb. Bring this up at your next review so your surgeon can investigate further.

If the bone where the implant sits cracks during surgery, you might feel sharp pain or notice swelling that seems out of proportion. This is a serious issue that requires careful attention from your surgical team.

Your surgeon will also watch for signs that the metal parts are rubbing together too much. This can cause wear and lead to the need for another operation later. If your pain returns or changes after a period of feeling better, let them know.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call us if you have a fever, increasing redness, or discharge from your wound. Seek emergency care for sudden severe pain, calf swelling, or shortness of breath. Contact us immediately if you lose sensation or cannot move your thumb. Limiting heavy thumb loads helps your new joint last longer. Your surgeon will guide you on when to stop wearing your splint before driving.