25445 Arthroplasty with prosthetic replacement; trapezium

Name of the Procedure:

Arthroplasty with prosthetic replacement; trapezium
Common Name(s): Thumb joint replacement, Basal joint arthroplasty

Summary

In an arthroplasty with prosthetic replacement of the trapezium, a surgeon removes the diseased or damaged trapezium bone in the thumb and replaces it with a prosthetic implant. This procedure is typically done to relieve pain and improve function in patients suffering from severe arthritis or other degenerative conditions affecting the thumb joint.

Purpose

This procedure addresses severe arthritis or degenerative disease of the thumb's basal joint, which can cause significant pain and limit hand function. The goals are to alleviate pain, improve thumb function, and restore the ability to perform daily tasks without discomfort.

Indications

• Persistent pain at the base of the thumb that does not respond to conservative treatments.
• Severe arthritis in the thumb joint.
• Loss of motion and strength in the thumb.
• Inflammation or deformity of the thumb joint.
• Difficulty in performing daily activities due to thumb pain.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Adjustments or temporary discontinuation of certain medications, as advised by the surgeon.
• Preoperative imaging studies (X-rays, MRI) to assess the condition of the thumb joint.
• Blood tests and overall health assessment to ensure patient fitness for surgery.

Procedure Description

1. The patient is positioned and given regional (local) anesthesia or general anesthesia, depending on the specific case.
2. An incision is made over the base of the thumb to access the trapezium bone.
3. The damaged or diseased trapezium is carefully removed.
4. A prosthetic implant is inserted to replace the removed bone.
5. The prosthesis is secured in place, and surrounding tissues are adjusted to ensure joint stability.
6. The incision is closed with sutures, and a sterile dressing is applied.
7. A splint or cast may be used to immobilize the thumb during the initial healing period.

Duration

The procedure typically takes around 1 to 2 hours, depending on the complexity and the individual patient's condition.

Setting

This procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon specialized in hand surgery
• Anesthesiologist
• Surgical nurses and technicians
• Physiotherapists for post-operative rehabilitation

Risks and Complications

• Infection at the surgical site
• Nerve injury resulting in numbness or weakness
• Prosthesis dislocation or failure
• Persistent pain or stiffness
• Complications from anesthesia
• Blood clots

Benefits

• Significant reduction in pain
• Improved thumb movement and strength
• Enhanced ability to perform daily activities without discomfort
• Long-term relief from arthritis symptoms

Recovery

• Patients may need to wear a splint or cast for several weeks to allow proper healing.
• Pain and inflammation are managed with medications and ice packs.
• Follow-up appointments are crucial to monitor progress.
• Physical therapy is often recommended to restore function and strength.
• Complete recovery can take from several weeks to a few months, depending on individual healing rates.

Alternatives

• Non-surgical treatments such as anti-inflammatory medications, cortisone injections, and physical therapy.
• Arthroscopy to clean the joint without replacing the bone.
• Fusion of the thumb joint, which can reduce pain but limits mobility.
• Pros and cons should be discussed with the healthcare provider to determine the most appropriate treatment.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-operatively, there may be soreness and swelling, which is managed with prescribed pain relief methods. Hand function gradually improves with physical therapy, and most patients experience significant relief from pain and regain improved thumb function within a few months.