The joint at the base of the thumb is the one that lets the thumb swing across the palm, and that mobility is exactly why it wears out. Arthritis here causes pain when you grip, pinch, open a jar or turn a key, and a deep ache at the base of the thumb afterwards. It is very common, particularly in women after fifty. Many people manage well for years with a splint, hand therapy and the occasional injection. Where that stops working, there are two operations that reliably take the pain away: removing the worn out bone, which is a trapeziectomy, or replacing the joint with the Touch prosthesis. Both are day procedures. Which one suits you depends on your X-ray, on your bone, and on what you need the thumb to do.
What is base of thumb osteoarthritis?
The joint between the thumb metacarpal and a small wrist bone called the trapezium is a saddle joint. It is what allows the thumb to rotate and oppose the fingers, which is the single most useful thing the human hand does. That range of movement comes at a cost: the joint surfaces slide across each other under high load every time you pinch.
Over time the cartilage wears, the joint becomes narrower, bone spurs form, and the ligaments that hold the joint together stretch. The base of the thumb can start to look squared off, and in advanced cases the thumb metacarpal rides up and the joint below the knuckle bends backwards to compensate.
Load through the thumb tip is multiplied many times over at the base of the thumb, which is why a joint this small produces pain this convincing, and why pinch is the movement that hurts most.
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Symptoms
Most people describe:
- Pain at the base of the thumb with gripping, pinching, or twisting a lid or a key
- A deep ache afterwards, often worse in the evening after a day of using the hand
- Weakness, and dropping things, because pinch has become both painful and weak
- A squared off or prominent appearance at the base of the thumb
- Stiffness, particularly first thing in the morning
- Difficulty with buttons, jar lids, taps, pegs and door keys, which is usually what brings people in
Pain at the base of the thumb has other causes, and De Quervain's tenosynovitis is the one most often confused with it. That one hurts on the side of the wrist rather than at the joint itself, and it hurts on thumb movement rather than on load.
Causes and risk factors
- Age and sex. Far more common in women, and most often becomes symptomatic after the age of fifty.
- Genetics. It runs in families, and often affects both thumbs.
- Previous injury. A fracture or a ligament injury at the base of the thumb accelerates wear, sometimes decades later.
- Ligament laxity. A naturally loose joint wears faster.
- Sustained heavy pinch, occupational or otherwise, although ordinary hand use is not the cause.
Arthritis at the base of the thumb often occurs alongside carpal tunnel syndrome, trigger finger and arthritis of the joints nearest the fingernails. Finding one is a reason to look for the others.
How it is diagnosed
By examination and an X-ray. The pattern of tenderness at the joint, and pain reproduced by loading and rotating the thumb, are characteristic. An X-ray shows how far the joint has worn and whether the neighbouring joints are involved. That matters for planning, and it matters a great deal for whether a joint replacement is an option at all.
Radiographic severity and symptoms often disagree. Some very worn joints hurt surprisingly little and some early ones hurt a lot. We treat the patient, not the X-ray, and the decision to operate is driven by what you can no longer do rather than by the film.
Non-surgical treatment
Most people should try this first, and many never need anything more.
Splinting
A splint that supports the base of the thumb takes load off the joint. Worn during aggravating activities, and often overnight, it is the single most useful non-surgical measure. A properly fitted splint that you will actually wear beats a better splint that lives in a drawer, which is why fitting matters more than the splint.
Hand therapy
Our therapists fit the splint, teach joint protection, and strengthen the muscles that stabilise the thumb. Changing how you open jars and turn keys sounds trivial and is not.
Corticosteroid injection
An injection into the joint can settle a painful flare and buy months of comfort. It does not repair the joint and the benefit usually wanes. We arrange these under ultrasound guidance, because the joint is small and placing the steroid accurately makes a real difference to whether it works. We would not repeat an injection more than twice in the same thumb.
Simple measures that genuinely help
Wider grips on tools and pens, a jar opener, lever taps rather than round ones, and anti-inflammatory gel rubbed into the joint. None of these change the arthritis and all of them reduce what it costs you.
Surgery
Where the pain is no longer controlled and it is limiting what you do, surgery is reliable. The principle behind every operation for this condition is the same: get rid of the worn joint surface, because that is where the pain is coming from. Where the operations differ is in what goes in its place.
We offer two.
A trapeziectomy removes the worn trapezium bone altogether and stabilises the thumb in the space that is left. It has the longest track record of any operation for this condition, the international hand surgery literature has for years concluded that removal of the trapezium is the treatment of choice for advanced cases, and there is no implant left in the thumb afterwards.
A joint replacement removes only the worn surfaces and replaces the joint itself with a small implant called the Touch prosthesis. The trapezium stays, so the thumb keeps its own height and length.
Both are day surgery. Both take the pain away. Each is described below, and then how the choice between them is made.
Trapeziectomy and suspensionplasty
The trapezium, the worn wrist bone that forms the lower half of the joint, is removed completely. Once the arthritic joint surface is gone, the pain source is gone with it. The thumb then has to be held in position while the space fills with scar tissue, and various methods are used to do that, including a strip of tendon taken from the forearm or a suture implant.
The method we use is a suture button implant, which is called a suspensionplasty. It holds the thumb metacarpal in position against the neighbouring index finger metacarpal while that scar tissue forms, and it avoids taking a tendon out of your forearm to do the same job.
An incision over the base of the thumb and a small incision on the back of the hand are required. Sutures close the skin, and a tape bandage covers them under a soft supportive hand and wrist dressing.
It is a day surgery procedure under a general anaesthetic with a local anaesthetic for comfort afterwards, and takes about 45 to 60 minutes.
Choosing between the two
Both operations take the pain away, so the choice is not about which one works. Neither is automatically the better operation, and the right one depends on your thumb rather than on a general rule.
At your consultation we will examine the thumb and go through your imaging to assess which of the two you are suited to. Some thumbs suit one operation and not the other, some suit both, and where both are reasonable we will talk through the trade and decide together.
In general terms:
- The trapeziectomy has the longer track record. Decades of it, and there is no implant left in the thumb to loosen, wear or dislocate later.
- The replacement keeps the thumb's own height and length, because the trapezium is not removed.
Recovery after either takes months rather than weeks, and the schedules for both are set out below.
What to expect from the result
Pain relief is the aim and it is what both operations deliver reliably. Most people notice the arthritis pain settling within the first few weeks.
Strength is the slower half, whichever operation you have. Useful pinch and grip come back over a matter of months rather than weeks, and strength and stamina keep building for up to a year afterwards. The detail differs a little between the two and it is set out in the recovery tables below.
Either way the thumb does not become normal, it becomes comfortable, and for almost everyone that is the trade they wanted.
Both are longer recoveries than most hand operations and that is worth knowing before you start rather than after. The single most common misunderstanding is the timeline. The pain relief arrives well before the strength does, and people who expect both at six weeks are disappointed by a result that is actually going perfectly well.
Recovery after a trapeziectomy, week by week
Indicative. Recovery here is measured in months rather than weeks, and hand therapy runs throughout.
Timeframe
What to expect
Day of surgery
Some or all of your fingers may feel numb or tingly for two to three days because of the local anaesthetic. You can move your fingers and the tip of your thumb before you leave hospital.
Days 1 to 5
Keep the dressing clean and dry. There will be swelling of the hand and fingers, best managed by keeping the hand elevated. You will see the hand therapist, who replaces the dressings with a custom made thermoplastic removable splint.
Days 5 to 14
If the hand feels comfortable the splint can be removed for gentle exercises and hand hygiene, but should be worn at all other times. The tape bandage can get wet when you clean your hand gently or shower. You can use the hand lightly wearing the splint, but avoid heavy tasks.
Two weeks
Your progress is reviewed by the doctor, hand therapist or practice nurse. If needed, a new tape bandage goes on for another three to five days. You can remove the splint more regularly to do hand and thumb exercises as instructed.
Four to six weeks
You can use the splint less as tolerated, or stop splinting completely. The wounds have usually healed by two weeks. Follow up appointments continue to monitor progress.
Three to six months
The area around the base of the thumb can remain somewhat tender or swollen through this period, but continues to improve. Useful strength also takes three to six months to recover.
Up to twelve months
Strength continues to improve for up to a year after surgery. Experienced hand therapists will assist you throughout.
Driving and work
Most people drive again once splinting stops, at four to six weeks. Office work is usually manageable at about two weeks, wearing the splint. Heavy work at around three months, in line with when useful strength returns.
Recovery after a joint replacement, week by week
Indicative. The splinting schedule protects the implant while bone grows onto it, so the early stages are less flexible than after a trapeziectomy.
Timeframe
What to expect
Day of surgery
Your hand and thumb may feel numb or tingly for up to 24 hours because of the local anaesthetic block. You can move your fingers before you leave hospital. Your thumb and wrist are supported in a plaster backslab.
Days 1 to 10
Keep the plaster clean and dry. Keep the hand elevated to reduce swelling. Move your fingers, elbow and shoulder regularly to prevent stiffness.
Days 10 to 14
Your progress is reviewed by the doctor, hand therapist or practice nurse, and the sutures are removed. The plaster is replaced with a custom made removable thumb spica splint fitted by your hand therapist. Gentle, guided thumb and wrist movement begins out of the splint.
Three to four weeks
The splint is gradually weaned during the day, while still worn at night and for protection. Hand therapy progresses to active thumb movement and light functional use of the hand. Heavy lifting, pinching and gripping are avoided.
Six weeks
Your progress is reviewed and new X-rays are taken. Most people have stopped using the splint by this time. Light to moderate use of the thumb is permitted, with strengthening guided by your hand therapist.
Three months
A graded return to heavier activities is started, including most work and recreational tasks.
Six months
Return to heavier manual tasks and sport. Follow up appointments continue as required to monitor your progress.
Six to twelve months
Full strength and stamina continue to build. The thumb may remain stiff, swollen or tender for several months, but this keeps improving.
Driving and work
Most people drive again once splinting stops, at four to six weeks. Office work is usually manageable at about two weeks, wearing the splint. Heavier activities, including most work, from three months, and heavy manual work and sport from six months.
Skin wounds heal in two to three weeks after either operation.
Hand therapy
Both of these operations depend on therapy more than most hand surgery does. The therapist fits and adjusts the splint, progresses the exercises at the right pace, manages the swelling and rebuilds pinch strength over months.
After a joint replacement the splint is a custom made thumb spica fitted at the ten to fourteen day visit, and the weaning schedule through weeks three to six is what protects the implant while bone grows onto it. That is a therapy job as much as a surgical one.
Having therapists on site means the splint is fitted the same week and adjusted whenever it needs to be, rather than at the mercy of another waiting list.
Risks and complications
Surgery at the base of the thumb is safe and routine, and complications are uncommon. Both operations share most of the same risks.
- Wound healing problems or infection.
- Bleeding or bruising. Usually minor and settles on its own.
- Stiffness or weakness, particularly through the first few months while strength returns.
- Nerve injury. Temporary or permanent changes in sensation in small patches of skin over the back of the thumb or the back of the hand may occur. The small sensory nerves on the back of the thumb are the ones at risk.
- Ongoing tenderness around the scar.
- Slower than expected recovery.
- Another procedure may be required in the future.
A joint replacement carries a few risks that a trapeziectomy does not, because there is an implant.
- The implant may dislocate, loosen or wear over time, in which case further surgery may be required.
- In a small number of cases the prosthesis is converted to a trapeziectomy in the future if persistent problems develop.
- Long term studies from Europe report high rates of patient satisfaction and low revision rates over five to ten years. As with any joint replacement, the lifespan of the implant is not unlimited.
When to be seen sooner
Contact us, or see your GP, if you have:
- Pain at the base of the thumb that is waking you at night
- A thumb that is becoming visibly deformed or is drifting into the palm
- Loss of pinch strength that is affecting your independence
- Numbness or tingling in the thumb, index and middle fingers, which suggests carpal tunnel syndrome as well
- Pain that came on suddenly after an injury rather than gradually
If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
Which operation will I have?
That is decided together. At your consultation we will examine the thumb and go through your imaging to work out which of the two operations you are suited to. Some thumbs suit one, some suit both, and where both are reasonable we will talk through the trade and decide together.
Will I lose the use of my thumb if you remove a bone?
No. In a trapeziectomy the trapezium is removed and the space it leaves fills with scar tissue, which the thumb then works against. The thumb stays where it should be, held by the suture button implant while that happens. You keep opposition, you keep movement, and you lose the arthritic joint that was causing the pain.
Is the joint replacement better because it is newer?
No, and newer is not a reason to choose an operation. The trapeziectomy has decades of results behind it, it remains an excellent operation, and for a great many thumbs it is the right one. The Touch is a good operation too, in the right thumb. Which of them suits you is a question about your joint, not about which is the more recent design.
How long will the implant last, and what happens if it fails?
Long term studies from Europe report high rates of patient satisfaction and low revision rates over five to ten years. As with a hip or a knee, the lifespan is not unlimited and nobody can give you a guaranteed number. If the implant loosens, wears or causes persistent problems, it can be converted to a trapeziectomy, which is the other operation described on this page. Choosing the replacement first does not close off the alternative.
How long do the operations take, and will I be asleep?
A trapeziectomy takes about 45 to 60 minutes. A joint replacement takes about 60 to 90 minutes. Both are day surgery procedures under a general anaesthetic, with a local anaesthetic given at the same time for comfort afterwards. You go home the same day.
Why a suture button rather than a tendon?
This one applies to the trapeziectomy. Both a suture button implant and a strip of tendon stabilise the thumb after the bone is removed, and both work. Using a suture button avoids taking a tendon out of your forearm, which means one less thing to recover from. We will go through the reasoning at your consultation.
How long before I can use my hand properly?
The splinting differs. After a trapeziectomy it continues for four to six weeks. After a joint replacement you are in a plaster for ten to fourteen days, then a removable splint that is weaned from about three weeks, and most people are out of it by six weeks.
After that the two follow much the same path. Useful pinch and grip return over a few months, and strength keeps improving for up to a year. Both are longer recoveries than most hand operations, which is worth planning around.
When can I drive and go back to work?
The answer is much the same after either operation. Most people drive again once splinting stops, at four to six weeks. Office work is usually manageable at about two weeks, wearing the splint. Heavier work starts at around three months, in line with when useful strength returns, and after a joint replacement the heaviest manual work and sport wait until about six months.
There is no legislation covering surgery and driving, so the test is whether you can control the car safely, including in an emergency. A splinted thumb is the limiting factor early on. Some insurers will not cover damage or liability if you had recent surgery, if you were wearing a splint or a cast while driving, or if you were taking pain medication that could affect your driving, so it is worth contacting your insurer before you plan to drive again. We will give you a realistic estimate for your specific job before the operation, and a certificate.
Can both thumbs be done at once?
No. You need one working hand throughout, and you are splinted for weeks after either operation. Where both thumbs need treating they are done separately. The interval depends on how quickly the first thumb recovers. As a guide it is around three months, and it can be sooner where recovery has gone well. We will talk about which side to do first.
Should I just put up with it?
Many people do, successfully, for years, using a splint and therapy and adjusting how they do things. There is no harm in waiting and the joint does not become unfixable. The operation is for when the pain is limiting you and the simple measures have stopped working.
Does an injection work?
It can settle a flare and buy months of comfort, and it is a reasonable thing to try. It does not repair the joint and the benefit usually fades. We arrange it as an ultrasound guided injection.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution before anything is booked. Phone the rooms on (08) 7127 0365 for an estimate.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 9 September 2026