05 / JOINT
Arthritis & Joint Reconstruction
Joint surgery is a decision about comfort, stability and useful movement. The right option depends on the affected joint and what you need from it. Changes on an X-ray alone do not make surgery necessary.
Understand the pathway01 / WHAT THIS TREATMENT ADDRESSES
Understand what can change.
Thumb base & finger joints
Painful thumb-base arthritis can interfere with pinch and grip. In selected cases, surgery removes or reconstructs a painful joint surface. Finger procedures may prioritise a stable joint through fusion or retain some movement through replacement.
Wrist arthritis
The wrist contains several articulating joints. The distribution of wear determines whether a motion-preserving procedure, partial fusion, total fusion or another approach is appropriate. One operation cannot suit every wrist.
02 / WHEN TREATMENT IS CONSIDERED
A reason to intervene.
A reason to be careful.
Treatment begins with the effect on daily life, examination and imaging. Activity changes, splints, therapy, suitable pain relief and sometimes injections may help. Surgery is discussed when symptoms remain unacceptable despite appropriate non-operative care. Inflammatory arthritis may also require rheumatology treatment.
03 / BEFORE THE PROCEDURE
A clear plan before the day.
Discuss the tasks you want to recover: pinch, tool use, lifting, fine work or sport. X-rays show the joints involved; selected cases need CT or other tests. Understand what movement would remain after fusion and what restrictions or future problems a replacement may bring.
Bring your questions.
Review medicines, allergies and health conditions with the team. Follow your own instructions about fasting and medication changes; do not stop prescribed treatment on your own.
Ask what help, transport and time away from work you may need.
04 / THE PROCEDURE
A PATIENT GUIDE / THREE KEY STAGESPrecision in every step.
The thumb carpometacarpal joint lies between the first metacarpal and the trapezium. Treatment targets this painful joint while considering thumb stability and useful pinch. Options differ between patients; the illustration does not assume a particular operation.
- First metacarpal
- Trapezium
- Thumb CMC joint
- Neighbouring wrist bones
The knuckle (MCP), middle (PIP) and end (DIP) joints have different roles and treatment options. The PIP joint is highlighted here. Selected reconstruction may preserve movement; fusion deliberately trades movement at one joint for stability. Not every arthritic joint needs surgery.
- MCP / knuckle joint
- PIP / middle joint
- DIP / end joint
- Affected joint surfaces
The wrist moves through several joints. The radiocarpal and midcarpal regions are highlighted. The location of cartilage damage determines whether a motion-preserving procedure, a partial fusion or a more extensive fusion may be appropriate.
- Radiocarpal joint
- Midcarpal joints
- Radius
- Ulna
Map the joint
Identify the painful articulation, remaining healthy surfaces and the movement worth preserving.
Reconstruct or stabilise
The agreed operation addresses damaged surfaces. Depending on the joint, this may involve excision, reconstruction, fusion or a selected joint replacement.
Protect the result
A dressing and appropriate support protect healing tissues. Therapy progresses around the needs of the reconstruction.
05 / ANAESTHESIA & THE DAY
The plan is personal.
Local, regional or general anaesthesia may be considered depending on the operation and your health. Some procedures are day cases; others need a short admission. Discuss the protection plan, help at home and therapy arrangements before choosing a date.
06 / RECOVERY
PROTECT → MOVE → STRENGTHENProgress has
its own pace.
These are guideposts, not personal clearance dates. Your operation, healing and clinical review determine the next step.
Thumb-base surgery
First weeks
Support the thumb
Dressings and a cast or splint protect the reconstruction.
About 4–6 weeks
Guided transition
Many trapeziectomy pathways gradually reduce support and develop movement, according to the surgeon’s protocol.
Following months
Pinch & grip rebuilding
Strength returns gradually. Heavy pinch and manual tasks may take longer than basic self-care.
Longer-term review
Settle into function
Improvement can continue for months; not everyone regains the same strength or comfort.
Fusion / replacement
Immediately
Protect the joint
Support and wound care follow the specific operation.
First several weeks
Check healing
Fusion needs bone healing; replacement needs soft-tissue protection and guided movement.
After clinical review
Increase use
X-rays, stability and your therapist’s assessment guide loading.
Longer term
Adapt & maintain
Some permanent movement or loading limits may remain. Implants can require ongoing review.
07 / RETURN TO LIFE
Back to the things
that matter.
- Work
- Plan around the operation’s effect on grip and dexterity. Heavy manual work can change which reconstruction offers the most appropriate balance.
- Driving
- Wait until support, pain and weakness no longer limit safe vehicle control. Your surgeon and therapist can help assess readiness.
- Exercise & therapy
- Therapy supports movement where intended and protects fusion or reconstruction. High loads may need lasting adjustments after some joint procedures.
08 / RISKS & CONSIDERATIONS
A balanced
decision.
Risks include infection, stiffness, sensitive scars, nerve irritation, persistent pain and reduced strength. Fusion may fail to unite. Replacement implants may loosen, wear or fail; revision can be required. The specific risks and alternatives depend on the joint and chosen operation.
09 / THE GOAL
Useful function.
Realistic expectations.
The aim is a more comfortable and useful hand, with realistic expectations about motion and strength. Surgery cannot recreate untouched cartilage or guarantee pain-free function. Recovery is shaped by the reconstruction, tissue quality and rehabilitation.
10 / YOUR QUESTIONS
Before you decide.
Does arthritis on my X-ray mean I need an operation?
No. The symptoms, examination and effect on function matter alongside imaging. Some radiographic changes cause little difficulty.
Is replacement always better than fusion?
No. A stable, less painful joint can be more useful than an unreliable mobile one. Suitability depends on the joint, tissues and demands placed on the hand.
Can an injection cure arthritis?
It may reduce symptoms in selected patients but does not restore worn cartilage. Benefit, risks and alternatives should be discussed individually.
CLINICAL READING
Sources & further reading.
General patient guidance to support a consultation. Your own surgical plan and discharge instructions take priority.
- BSSH · Basal thumb arthritis
- BSSH · Terminal finger joint arthritis
- AAOS · Arthritis of the wrist
- Cambridge University Hospitals · Trapeziectomy recovery
- South Tees Hospitals · Trapeziectomy rehabilitation
- Anatomy reference · Thumb-base joint treatment
- Anatomy reference · Finger joint reconstruction
- Anatomy reference · Wrist joint treatment
- Royal College of Anaesthetists · Preparing for surgery
- Chelsea and Westminster Hospital · Before hand surgery
A CONSIDERED NEXT STEP
The right treatment starts
with the right diagnosis.
Understand your options, discuss the trade-offs and plan a recovery that fits your life.
PROF. DR. SAMI HASSAN / HEALTHPOINT