What it is
Joint replacement surgery for the hand most commonly addresses painful thumb CMC arthritis. Options include trapeziectomy with ligament reconstruction and tendon interposition, implant arthroplasty, or suspension techniques. In selected cases, finger joint arthroplasty is considered. The goal is to achieve pain relief and maintain functional pinch and grip for daily life.
Rehabilitation restores safe motion, strength, and confidence. Lifelong load limits may be advised to protect the result.
What happens when it occurs
The arthritic surfaces are removed or resurfaced, and stability is restored using soft-tissue or implant techniques. Early therapy protects the reconstruction, guides motion, and builds strength in a gradual and staged approach.
Common causes and indications
- Persistent pain and disability from osteoarthritis despite a thorough non‑operative programme
- Failure of splints, injections, and strength measures
- Clear functional goals that suit the procedure
Who is most affected
Older adults, more often women, with thumb base arthritis frequently experience limitations in daily tasks.
Typical symptoms before surgery
- Deep ache and weakness at the thumb base
- Difficulty with keys, jars, opening packets, and prolonged pinching
- Sleep disturbance during flares
When to seek care
When pain and function remain limited despite a clear programme, and other procedures are not suitable.
How we diagnose
History, examination, and X‑rays. Procedure selection is individualised to goals and anatomy.
Management
- Splinting and protection early, then guided motion
- Progressive strength for the thenar and first dorsal interosseous muscles
- Grip and pinch endurance circuits within limits
- Education for joint protection and home setup
- Task practice and graded return to hobbies and work
Rehabilitation milestones
Phase 1 weeks 0–2: protection in splint or cast, finger motion, oedema control.
Phase 2 weeks 2–6: gentle range and activation under protection, scar care.
Phase 3 weeks 6–12: progressive strength, pinch retraining, graded tasks.
Phase 4 months 3–6: community and hobby goals with adherence to load limits.
Readiness to progress
- Pain and swelling are controlled
- Stable reconstruction and improving pinch strength
- Daily tasks completed without next‑day flare
Long-term care
- Respect lifting limits set by your surgeon
- Maintain hand and forearm strength
- Use supportive splints for heavier or prolonged tasks
Australia snapshot
- Lower volume than hip or knee replacement, yet common in hand centres
- Day‑surgery and short‑stay pathways are standard
- Rehabilitation services support early discharge and home programmes
Latest insights
Education and daily practice shape function more than the choice of implant.
Pinch retraining and thenar strength drive independence.
