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 Want to Avoid CMC Joint Surgery?

Have you been told you have thumb osteoarthritis (OA) and that you need surgery? The joint at the base of the thumb allows for a wide range of movement, allowing constant swiveling and pivoting motions for writing, typing, scrolling on a phone, and almost all other daily activities. Basal joint thumb arthritis or carpometacarpal (CMC) joint arthritis is the wearing out of cartilage at the base of the thumb, near the wrist. Because the hands are so integrated into almost every facet of everyday life, the cartilage here can wear out easily. In fact, hand and thumb OA are the second most common types of arthritis. While there are surgical options available, none have shown in research to be effective or free of significant risk of complications.

Meet the Percutaneous Carpalmetacarpal Arthroplastly (or the “Perc-CMC Arthroplasty” for short), the innovative Regenexx procedure for the treatment of CMC joint that helps preserve function, mobility, and decrease pain by using image guided injections to place bone marrow concentrate (containing stem cells) and/or PRP to facilitate recovery from OA. It is the trusted alternative to CMC joint surgery. 

 

Meet the Perc-CMC Arthroplasty

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What are the stages of Osteoarthritis in the Thumb?

CMC joint osteoarthritis is a chronic, painful condition that involves the breakdown of the cartilage in the thumb.  CMC joint osteoarthritis has 4 major stages based on severity.  This is illustrated in the x-rays to the right.

Stage 1 / Image A 

Subtle thumb space widening.   

Stage 2 / Image B

Subtle thumb space narrowing, bone spurs, and loose bodies < 2mm. Image B.

Stage 3 / Image C

Advanced thumb space narrowing, bone spurs, and loose bodies > 2mm

Stage 4 / Image D 

Advanced thumb space narrowing, bone spurs, loose bodies, and arthritis in the neighboring hand joints.  Image D

What Are My Surgical Options? And Why Is the Perc-CMC Arthroplasty Better?

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  1. Ligament Reconstruction – This procedure stabilizes the CMC joint by removing a portion of the damaged ligament and replacing it with a piece of the patient’s wrist flexor tendon. However, it does not repair the bone or the cartilage.
  2. The Ligament Reconstruction and Tendon Interposition (LRTI) – This is the most often used treatment for the thumb arthritis. In this surgery, the damaged joint’s surfaces are replaced with a cushion of tissue that separates the bone. To do this, the trapezium bone in the base of the thumb is partly or wholly removed. Then, a nearby tendon is detached at one end and passed through a hole drilled in the thumb’s metacarpal bone. Removing the trapezium is supposed to lessen the chance that arthritis should return, but a 2009 study found that 22% of patients undergoing this study saw adverse effect, including the persistence of chronic pain (2).
  3. Total Joint Replacement – In this procedure, the surgeon removes all or part of the damaged thumb joint, replacing it with an implant. A recent review on the topic showed that for some the procedure worked, but for others, it was ineffective or resulted in more surgery (3).

FAQ


 

Unfortunately, there is little to no high-level evidence that invasive procedures like CMC joint surgery work well in most patients. While there are different high-level studies on the different surgical options and procedural choices available to surgeons, they are very small studies.

Additionally, most patients are under the false impression that, because surgery is often suggested as a last resort in the clinical decision tree, after more conservative treatment options like drugs or physical therapy, CMC joint surgery must be a definitive end to their pain problems. There is a common assumption that, after surgery, all of the patient’s thumb pain will subside and all normal hand function will return, pain-free. Sadly, the little research the medical community does have on these surgeries does not paint that picture of recovery.

On average, patients who have undergone CMC joint surgery will still have mild to mild-moderate pain in their joints. Even more concerning is the data that shows that patients also continue to report mild to moderate loss of hand function post-surgery. On top of all of these potential post-surgical outcomes, there is a very high complication rate of 22% in the most common method of CMC joint surgery, which is the aforementioned joint removal plus tendon insertion, or trapeziectomy and tendon interposition. As one can see, when the research is done, there is no lasting proof that CMC joint surgery will solve arthritic problems, and could actually cause lasting detrimental side effects.

In plenty of patients with CMC arthritis, physicians will recommend CMC joint surgery…but is it truly necessary? If you have debilitating or even moderate CMC arthritis pain, your doctor may have advised you to undergo thumb or hand surgery. The most common form of CMC joint surgery is to remove all or part of the wrist bone that comprises the base of the thumb joint. The idea behind this surgery is that, if the joint is causing a patient pain, the joint should be removed.

However, there are myriad problems with removing the thumb joint as the source of arthritic pain. Once the joint is removed between the base of the thumb and the wrist, that area will collapse under the pressure of the thumb.

How is this remedied? One option is to take a tendon from the hand and coil it up and stuff it into the space that would be collapsed. Recent research, however, shows that this fix is associated with twice as many side effects as normal. Another option is to drill a rubber band-like device into the bone of the thumb and adjacent bones to keep the area at the base of the thumb from collapsing. Unfortunately, there are no non-invasive aspects to this type of joint surgery.

In a word, no. Thankfully, there is an alternative to this type of invasive surgery, and it is one we practice at Centeno-Schultz. Our approach to orthopedic care, and an alternative to CMC joint surgery, is called Interventional Orthopedics. Our Percutaneous CMC Arthroplasty Procedure (also called a Perc-CMC Arthroplasty for short) is for the CMC, thumb/basal joint, and it is a non-surgical treatment that has truly been a breakthrough for our patients suffering from pain, reduced range of motion due to basal joint arthritis, or other more long-term degenerative problems in the hands.

 

Our patented protocol alternative to CMC joint surgery is far more complex than patients will find at other clinics; everything about this treatment is designed for results. The Perc-CMC Arthroplasty is non-invasive, and treatment recovery calls for minimal downtime or missed working hours. We have extensive published patient outcome data on the effectiveness of our procedure, which involves precise, image-guided injections performed by musculoskeletal specialist physicians. Before you consider CMC joint surgery as a solution to your arthritis problems, explore alternatives and options outside of surgery, and allow our team to show you what makes our clinic unique, and determine whether you are a candidate for our alternative Perc-CMC Arthroplasty procedure.

Ready to find relief?

Life is too short to live in pain. If you’ve been recommended hand surgery, we want to provide you an alternative that minimizes complications and ensures optimal and lasting results. Take advantage of our innovative treatments that help people just like you avoid CMC joint surgery and other invasive surgeries, allowing them to get back to doing the activities they love, faster and without surgery.

References

(1) Kennedy CD, Manske MC, Huang JI. Classifications in Brief: The Eaton-Littler Classification of Thumb Carpometacarpal Joint Arthrosis. Clin Orthop Relat Res. 2016;474(12):2729-2733. doi:10.1007/s11999-016-4864-6.

(2) Wajon A, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD004631. doi: 10.1002/14651858.CD004631.pub3. Update in: Cochrane Database Syst Rev. 2015;2:CD004631. PMID: 19821330.

(3) Huang K, Hollevoet N, Giddins G. Thumb carpometacarpal joint total arthroplasty: a systematic review. J Hand Surg Eur Vol. 2015 May;40(4):338-50. doi: 10.1177/1753193414563243.

Centeno-Schultz Clinic is the headquarters of Regenexx, located in Broomfield and Lone Tree, Colorado. The Broomfield is located for the convenience of patients in Longmont, Thorton, Westminster, Arvada, Superior, Denver, and Lousville, and the Lone Tree clinic is meant for those in Aurora, South Denver, Littleton, and Centennial.