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: 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.

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.

Why this operation has been suggested

This page reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic. We suggest this procedure when wear-and-tear arthritis in the base of your thumb causes pain and stiffness that has not improved enough with non-surgical care. We usually try activity changes, therapy, splints, or injections first. If these do not give you enough relief, surgery may be the next step.

Total joint replacement restores the joint between your thumb bone and wrist bone. It aims to reduce pain, improve movement, and restore strength. For patients with isolated arthritis in this joint, the Touch® implant shows a 96% survival rate at 2 years. This means the device remains in place and functional for most people over that period. We view this as a shared decision to help you regain daily function.

Before the operation

Please fast for six hours before your surgery. Stop taking blood thinners only after your surgeon gives specific instructions. Arrange a lift home and bring a list of all current medications. You will need recent X-rays to map your joint. Blood tests check your overall health. An anaesthetic review ensures you are safe for sleep. Wear loose, comfortable clothing to our clinic. We want you to feel prepared and calm. Your surgeon will guide you through each step. This simple preparation helps us focus on your comfort and safety during the procedure.

On the day

You will arrive at the hospital and be admitted to your room. Our team will guide you through the final checks. You will meet your anaesthetist to discuss your comfort and safety. 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.

You will then be taken to the operating theatre. Our surgeon performs this procedure using an open approach with a single conventional incision over the operative site. This allows clear access to the joint. Once the surgery is complete, you will wake up in our recovery area. Our nurses will monitor your progress closely. You will rest here until you are stable and ready to go home. We will provide you with clear instructions for your first day of recovery.

What the operation involves

Your surgeon makes a single cut over the base of your thumb to access the joint. This open approach allows clear visibility of the trapeziometacarpal joint, also known as the thumb base joint. The surgeon removes the worn-out joint surfaces caused by osteoarthritis, or wear-and-tear arthritis.

A metal and plastic implant replaces the damaged joint. Your surgeon carefully prepares the bone bed to fit the new components. This involves shaping the bone cavity and securing the implant cup into place. Correct positioning of these parts is crucial for a reliable result. The surgeon ensures the implant sits securely to restore normal thumb alignment and length.

Once the new joint is in place, your surgeon closes the cut with stitches or staples. A dressing is applied to protect the area. The procedure focuses on removing pain-causing bone spurs and restoring smooth movement. Limiting heavy loads on the thumb after surgery helps protect the new joint and supports its longevity.

After the operation

You will wake up in the recovery ward with your hand in a sling and a protective dressing. We manage pain using standard methods to keep you comfortable. Most patients stay one night in hospital after this operation, though some are able to go home the same day. You must have someone stay with you for the first 24 hours. We advise limiting thumb loads to support healing. You will wear a thumb spica splint for four to six weeks. Do not drive while the splint is on, as it stops you gripping the wheel safely. You may drive once the splint is removed and your surgeon clears you. See Driving after upper-limb surgery.

Recovery

You will have a single incision over the base of your thumb. In the first few days, swelling and stiffness are normal. Your surgeon will guide you on managing this discomfort. We keep your thumb protected in a splint to let the tissues heal. This support helps limit strain on the new joint, which supports the longevity of your procedure.

You will wear a thumb spica splint for four to six weeks. Do not drive while wearing this splint. It prevents you from gripping the steering wheel safely. You can return to driving once the splint is removed and your surgeon clears you. For more details, see Driving after upper-limb surgery.

As movement returns, you will begin gentle exercises. Hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. Your therapist will help you regain strength and dexterity. You will gradually resume light daily tasks as pain allows. Your timeline may differ; your surgeon and physio will guide you.

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.

Sometimes the implant may not stay firmly in place. This is called loosening. You might notice a deep ache in your thumb that does not go away with regular painkillers. The pain may feel worse when you try to pinch or grip things. If this happens, call our clinic so we can check your thumb.

The plastic part inside the joint replacement can sometimes break. This is known as liner fracture. You might feel a sudden click, grind, or pop in your thumb. There may be new swelling or pain that seems to come on quickly. Because this can be hard to see on standard X-rays, we need to examine you carefully. Please bring this up at your next review or call us sooner if the pain is severe.

In rare cases, the bone where the implant sits can crack. This is a trapezial fracture. You might feel sharp pain and see swelling right after the surgery or during early recovery. If you feel a sudden snap or intense pain, stop using your hand and contact our team immediately.

We also want to be clear about what to avoid. Some older types of joint replacements have shown higher rates of needing further surgery. We do not use those specific designs. Our focus is on implants that have proven stable over time. If you are worried about the long-term feel of your thumb, we can discuss this with you.

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

When to call us

Call us if you develop a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or inability to move your thumb. We want to catch any issues early. Please contact our clinic immediately if any of these symptoms occur so we can assess you promptly.