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

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For wear-and-tear arthritis, we usually try non-operative care first. We consider surgery when that has not given enough improvement.

Your surgeon may recommend this joint replacement if you have isolated thumb base arthritis. The procedure aims to reduce pain and restore function. Evidence shows a 96% implant survival rate at 2 years. This supports the recommendation for patients with isolated trapeziometacarpal joint osteoarthritis. The operation targets low pain levels, improved mobility, and high patient satisfaction.

Before the operation

You must fast for seven hours before your procedure. Stop taking blood-thinning medications as your surgeon advises. Arrange a ride home, as you cannot drive yourself. Bring a list of all current medicines and wear loose, comfortable clothing. You may need an anaesthetic review to check your fitness for surgery. X-rays or blood tests might be required to plan your care safely. These steps help ensure your operation proceeds without delay. We want you to feel prepared and confident. Your surgeon will provide specific instructions tailored to your health needs. Please follow these guidelines closely to support a smooth experience.

On the day

You present to the hospital’s surgical admissions unit for check-in and preparation. You meet the anaesthetist to discuss your care. 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 are then taken into the operating theatre, where the operation is performed. You wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves

Your surgeon makes a single cut over the base of your thumb to reach the joint. This is an open approach, meaning the area is accessed directly rather than through small keyhole holes. Through this opening, your surgeon removes the worn-out joint surfaces. These are replaced with a metal and plastic implant to restore smooth movement.

Correct positioning of the implant is crucial for reliable results. Your surgeon carefully prepares the bone to ensure the new joint sits securely. This attention to detail helps avoid complications such as bone fractures or early failure of the implant components.

Once the new joint is in place, your surgeon closes the cut with stitches. A dressing is applied to protect the area as it begins to heal. Limiting heavy loads on your thumb after the operation may help the procedure last longer.

After the operation

You will wake up in the recovery ward. Your surgeon will manage your pain and check your wound. We apply a dressing and a splint to protect your thumb. Most patients stay one night in hospital after this operation, though some are able to go home the same day. Someone should stay with you for the first 24 hours. You must not drive while wearing the splint, as it stops you gripping the wheel safely. You can drive once the splint is removed and your surgeon clears you. Read more about Driving after upper-limb surgery.

Recovery

Your thumb will feel sore and swollen at first. This is normal. We use ice and elevation to help ease the discomfort. Limiting heavy loads on your thumb supports the longevity of your procedure. You will wear a thumb spica splint for four to six weeks. This protects the joint while it heals.

We work with Ruby Doolan at Extend Rehabilitation for your hand therapy. She guides you through gentle exercises to restore movement. You will start with simple motions. As swelling settles and your surgeon clears you, you will progress to stronger grips. You cannot drive while wearing the splint. It stops you from gripping the wheel safely. Wait until the splint is removed and your surgeon gives the green light. See our guide on driving after upper-limb surgery for more details.

Daily tasks change at first. You may need help with buttons or lifting pots. Focus on protecting the thumb. Sleep with your hand elevated on pillows. Your timeline may differ; your surgeon and hand therapist will guide you. As movement returns, you will notice improved function and less pain. Your surgeon aims for low pain levels and high satisfaction. We focus on restoring your thumb’s length and strength. Trust the process. Let the healing happen naturally under our care.

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 signal that the implant has loosened from the bone. If this happens, call the clinic to arrange a review.

Sudden swelling, tenderness, or a clicking sensation in your thumb joint may indicate instability. This means the artificial joint is not sitting securely. Contact your surgeon promptly if you notice these changes.

You might experience increased pain or stiffness that worsens over time. This can be a sign that the implant is wearing out or failing. Bring this up at your next scheduled review so your surgeon can assess the joint.

If you notice redness, warmth, or drainage from the incision site, it could be an infection. Seek medical advice immediately if you suspect an infection.

Some complications may not show clear signs on standard X-rays. You might feel a grinding sensation or have unexplained pain despite normal-looking scans. Tell your surgeon about any unusual feelings in your thumb during follow-up visits.

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

When to call us

Call us if you have fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling or shortness of breath. Seek urgent care for loss of sensation or inability to move your thumb. We are here to help you recover safely.

Where to read more

This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Basal Thumb Arthritis page.

Where to read more

This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Basal Thumb Arthritis page.