Thumb operation that means you can open jars again
Osteoarthritis of the thumb affects up to 12 per cent of adults. Paul Barrett, 67, a retired Navy officer from Purbrook, Hampshire, took part in a trial of a new implant to treat it, as he tells LUCY HOLDEN.
THE PATIENT
One of my favourite hobbies is DIY. I enjoy it all, even putting in a new staircase, as I find it therapeutic. Dad was a woodwork teacher, so I inherited this love from him.
But in 2013, my thumbs started to ache and I began to find it difficult to open jars and turn door handles — they hurt so much when I tried to grip things.
I had a blood test to find out if it was rheumatoid arthritis, but the results came back clear.
Paul Barrett, 67, a retired Navy officer from Purbrook, Hampshire, took part in a trial of a new implant to treat osteoarthritis after his joint pain meant he couldn't enjoy DIY anymore (file photo)
I hoped the pain would improve, but gradually it got worse. My wife, Anne, was having to do up my shoelaces and shirt buttons for me, and I couldn’t do DIY for more than an hour because of the excruciating pain and stiffness.
I could feel and hear the bones at the base of my thumbs grinding, particularly in my right hand.
I don’t like sitting still so not being able to work properly was making me miserable.
I went back to my GP in January 2015. He said it might be osteoarthritis and referred me to have an X-ray, which I had a week later. It showed osteoarthritis in both thumbs.
The doctor explained that the cartilage around the joints had worn away — partly due to years of manual work.
It meant the two bones in my thumbs were grinding against each other, causing pain and restricting movement.
I was worried I wouldn’t be able to use my hands properly again. The doctor reassured me there were treatments: steroid injections to reduce inflammation and, if they didn’t work, surgery to cut out the bone that was grinding and causing pain.
He said: 'A year on, I’m completely pain-free and am back working around the house. I feel as though I’ve never even had arthritis in my right hand' (file photo)
I tried steroid injections first, which were not a success. I was ready to go back and have surgery, but was diagnosed with prostate cancer in February 2015, so I had to wait until the cancer treatment had finished.
Luckily, I was given the all-clear in August 2015.
I went back to the hospital and was told that a new trial for a thumb implant was starting. The consultant said it involved inserting a rubbery implant between the two bones to replace the lost cartilage.
I was asked whether I’d like to join the trial — it would mean they wouldn’t have to remove the bone in my thumb and I would retain better movement and grip in my hand.
That sounded like a no-brainer, so I said yes. We agreed that they would try it in my right thumb first because it was worse than my left one.
I had to wait for the trial to start and had the procedure under general anaesthetic in March 2016.
When I woke up, my arm was numb and I had a slight ache around my thumb, but I didn’t need painkillers.
I went home with my arm in a cast and couldn’t do very much for six weeks. Then I had a splint taped between my wrist and thumb to hold it in place for another six weeks. I think they were just being extra cautious because it was a trial, but I could already feel that the grinding had disappeared.
I had hand therapy for six weeks at the hospital to help strengthen my thumb and ease the joint back into a full range of movement.
A year on, I’m completely pain-free and am back working around the house. I feel as though I’ve never even had arthritis in my right hand.
I can do up my shirt buttons, open jars and turn door handles without any problems.
I am hoping to have the same operation soon on my left thumb, which is gradually getting worse.
THE SURGEON
Philip Sauve is a consultant orthopaedic surgeon at the Queen Alexandra Hospital in Portsmouth.
Osteoarthritis in the thumb is incredibly common, because whenever we hold a pencil, undo a bottle top or twist a key into a lock, a lot of force is channelled through the joint.
It is sometimes the result of overuse of the joint, which destroys the cartilage — the buffer between bones — meaning bone rubs on bone, which causes pain, stiffness and can reduce movement. It’s also thought that injury can bring on osteoarthritis by damaging the cartilage, or it may be that genetics are to blame.
What are the risks? As with any operation, there is a risk of infection. Patients can develop chronic regional pain syndrome (pain sensitivity in that area). The thumb could feel unstable or the implant may loosen or wear out. ‘It may carry less risk than other treatments for thumb osteoarthritis,’ says Elliot Sorene, a consultant surgeon at the London Clinic. ‘Patients can react to the metal, silicone or rubber used in other implants. This gel could act as a cushion.’
We can offer steroid injections, which are anti-inflammatory and take the edge off the pain.
How effective they are varies. They work less well when the arthritis is more advanced, which is why they didn’t work brilliantly for Paul.
When steroid jabs don’t work, we offer surgery called trapeziectomies — where we remove the trapezium bone at the base of the thumb, which acts like an anchor and holds the thumb in place at the joint.
This involves opening up the thumb joint, removing the bone and letting the scar tissue heal in its place.
Patients wear casts for several weeks to keep the hand in a fixed position and allow scar tissue to form.
The downside is that removal of bone means the thumb sits nearer the wrist, which reduces its movement and a patient’s ability to grip properly.
But we are trialling an implant called Cartiva — a synthetic cartilage implant.
It comes in one size and is already used to treat osteo-arthritis in the big toe.
Because that joint is similar to the thumb, doctors thought that the implant could work well there, too.
The rubbery implant is about 1cm wide and 8mm long, and is made of a gel that has a similar consistency to cartilage: firm, but flexible.
Patients have the option of being awake for the operation and just having a local anaesthetic, or they can opt for a general anaesthetic.
Osteoarthritis of the thumb affects up to 12 per cent of adults in Britain. Osteoarthritis in the thumb is incredibly common, because whenever we hold a pencil, undo a bottle top or twist a key into a lock, a lot of force is channelled through the joint (file photo)
We first make an inch-long incision at the base of the thumb (palm side down) and expose the end of the two bones that are rubbing.
We then make an 8mm hole at the end of the bone in the thumb and squeeze in the implant.
Then we sew the incision using dissolvable stitches.
The whole procedure takes about 45 minutes, and the patient can go home the same day. In the trial, patients spend about six weeks in plaster casts and then have a splint fitted for another six weeks to help the thumb heal properly.
With the gel implant, the recovery period is longer than after standard surgery, but it’s because we’re being extra careful until we’re more familiar with it.
Six weeks of hand therapy improves movement and strengthens grip, meaning everyday tasks such as turning keys and buttoning a shirt become possible.
You get much less function when you remove the thumb bone. It’s still early days, but the results look good so far and should be released officially by next year.
The first phase of the trial in 50 patients at ten hospitals in the UK and Canada has finished.
A second phase should start later this year at the Queen Alexandra Hospital and other hospitals elsewhere in the UK.