Advanced thumb joint arthroplasty at Norton Arm & Hand Institute provided durable function and strength, enabling return to work in a challenging arthritis case.

Published: September 11, 2025

The patient

A 45-year-old man with bilateral thumb carpometacarpal joint arthritis for several years (Figures 1 and 2): He tried bracing and steroid injections, which eventually provided diminishing relief. He works as a mechanic for UPS but was having an increasingly difficult time at work due to pain and loss of pinch and grip strength.

The challenge

Traditional surgery to treat thumb carpometacarpal joint arthritis involves removing the trapezium bone and allowing scar tissue to form or interposing a tendon to create a new articulation. By removing the trapezium, pain can be relieved; however, strength can be difficult to regain because of shortening of the muscles. Also, younger patients can have subsidence of the first metacarpal onto the trapezium over time, causing discomfort. With the trapezium removed, it is difficult to return to manual labor.

The solution

Thumb metacarpal joint arthroplasty with an implant was performed on the left hand (Figure 3). The first metacarpal bone was resected at the base, and a socket was created in the trapezium. The modular thumb implant was then inserted into the first metacarpal and articulated with the trapezium.

The result

The patient was immobilized for four weeks, allowed to start range-of-motion exercises in the second month and strengthening during the third month. He subsequently underwent surgery for the right side with the same rehabilitation protocol. The patient was able to return to work as a mechanic and regain much of his strength. He can use his thumb and reports that he often forgets that there is an implant present.

The physician

Antony Hazel, M.D.

Hand Surgeon

Norton Arm & Hand Institute