CMC Arthroplasty with STABLYX Implant

Hi Everyone! My name is Richard and I am a Surgical Tech. I am a night shift trauma tech at a Level 1 hospital and am looking into the Stablyx system. My concern is the recovery and recovery time. I have to have use of my thumbs for surgery, if I cannot recover to probably at least 85% in a reasonable amount of time I risk losing my job and/or being classified as permanently disabled. I am 58 and cannot be forced into disability at this point. So, I am terrified. I know the surgeon I will have do this, have known and worked with him for about 15-20 years so no problems with that. Is the recovery just a luck of the draw thing? I mean, working in surgery I know it is always luck of the draw just some things are easier than others. Right now I am probably 80-85% on left (dominant) and about 90-95% on right. My main question, after seeing some of you waited until you could not even pick up a glass is should I wait another few years if possible or get it done now? I am bone on bone on left hand. I normally do not do CPR compressions in trauma as I am set up, sterile, and ready to cut. A few weeks ago I did wind up having to do compressions and it was excruciating, no matter how I positioned my hands. I am looking at maybe doing this at the beginning of March and just wanted some input and thoughts before I do something that may end my career in surgery. Any other medical people have this done? Would most of you wait until unable to work any longer or get it done when it is not as bad and hope that would help the recovery more? All thoughts are greatly appreciated!!

Hello Richard, and welcome to Mayo Connect. We are a community of people, living with a variety of diseases and conditions, who try to share our experiences and help each other on our journeys. We are not medical professionals, hence we do not give medical advice.

I am a now retired female, very active seamstress, gardener and involved grandma who has had CMC repair done on both thumbs. At my age, I also have a great many friends who have had the procedure as well. So I will share some of that.

Based on the experience of friends, and on previous hand and wrist surgeries, I knew I needed to find and experienced hand surgeon, who does many CMC procedures and uses more than one technique. I did this by consulting with my trusted hand therapist and hip surgeon to see who in our area had the best results and reputation. You obviously have had the advantage of watching the surgeons in action.

I had each thumb done when it was at about 50-65% and steroid injections didn't help any more. The doctor cautioned that if I waited longer, I was in danger of requiring complete fusion surgery. This is the first thing to discuss with your hand surgeon. I had two friends who didn't believe me, waited until the joints collapsed, and ended up with full fusion and limited use.

The first surgery was 2 1/2 years ago, the surgeon explained 3 techniques, the traditional "anchovy" using tendon from my arm, "tightrope" surgery using two anchors and a nylon(?) tightrope to keep everything aligned, and using an introduced blood clot in place of the tendon.
He recommended the "tightrope" as having higher success and a shorter healing time. I was at 65% 8 weeks post surgery, 80% at 3 months. I was back to sewing and tending toddlers after 8 weeks. Occasional swelling occurred with overuse for about 6 months. I now have full use of that hand, but haven't tried doing CPR!

In June, I knew the second hand, my dominant left needed to be done, and I was as at maybe 50%, and found a new surgeon (the first, most excellent one moved away.) I asked about an implant because a friend had gotten it, and it seemed successful after a year. As a petite female with advanced osteoarthritis, my hand surgeon told me he would not consider Stablyx implants because they are (his word) finicky and he felt I didn't have enough bone for successful fusion. We again selected the tightrope as the best method, his placement of the pins and tightrope was a bit different than the first, and at 6 months I have 90% recovery on that hand and better range of motion than the first, with no pain or swelling.

I have spent much of 2020 sewing (masks and quilts) manipulating large swaths of fabric and using rotary cutters extensively with this new repair, and can say it was a success. After observing numerous friends have the CMC repairs with varying success, I believe that no matter which avenue you choose, the key is faithful PT/OT to recover use and strength. My friend and I who were diligent have few if any limits to what we can do. Others who were less so have more stiffness, pain and weaker grip.

Side note: With properly functioning thumbs, arthritis pain has subsided in my hands a bit as I am using them correctly again, not always trying to compensate for the painful, useless thumbs.

I wish you luck with whichever option you choose. If I were considering Stablyx, knowing it can fail, I would ask the surgeon what my options would be if it turned out not to work..
Sue

As long as you have time on your side, keep researching this topic. There are many options to consider and your situation at work seems to be the biggest consideration. I found this video on YouTube interesting, dealing with a BioPro prosthetic implant. YouTube has video testimonies which I found to be helpful as they relate to some of the issues I was facing. I am 62 years old and just turned the 3-year corner on my left thumb, Stablyx surgery.
https://www.youtube.com/watch?v=OaVEb8xzG80

Thanks y'all ! My fear is the recovery time which I know cannot be predicted. Like I said I work with these guys pretty regular in trauma on the weekends. I will talk to the doc who recommended the stablyx. His name is Edmund Rowland in Denver. Kinda funny because the younger hand guys recommended the tightrope and tendon transposition. He said that was a end run commitment. If the stables does not work you can still have those done. If you do those first and the bone is removed you cannot do the stablyx, that is why I am really looking at that. Steroid shots last about 2-3 weeks so they are near useless. For now I wear a wrist/thumb brace unless I am scrubbed in surgery. Fortunately I am the primary weekend night trauma tech so I am not usually in surgery for my full 12 hour shift. I will continue keeping Dr. Rowland posted and I'll let you all know my progress and decisions. I am really happy I found this forum so I can get a patient perspective rather than the surgical side. I know the Fed's and Dr. Rowland knows the guy at Skeletal Dynamics who designed it. I have done distal radius repairs numerous times using their distal radius set and have been really impressed from a surgical standpoint. Thanks again and I'll keep you all posted!

Hello Richard,
Shamu here. I am only a common 61 year old who has worked with my hands all my life. Now not anything like you do though. I am currently still employed and I do shipping and part inspection and identification in a large machine /model shop and use my hands every day doing everything from using small tools to placing small parts in small zip lock bags. Zip lock bags suck! The small 3 inch ones kick my butt when I have hundreds to do. That thumb on forefinger slide job still irritates the joint. I had my right hand done with the Styblix in May 2019. I had my left hand done in November 2019. No regrets in my case. That being said, I am my own boss for the most part and anything I can't do myself, I found help from others in the shop to help. I have documented my two events earlier in this thread.

It's been 18 months and my right hand is doing real well. I have been using all my experience from the right to deal with bringing along the left. For me and my situation I made the right choice. I feel at the 2 year mark I will be at the advertised success rate of having a 95-98 % use back with some manageable slight pain issues. I never expected 100% recovery. We as a race can never match the creators product.

Can I live my life normally now? Yes. Do I notice issues? Yes. Do my hands work as they did 20 years ago? No. Are they as nimble? No. Do I have any pain? Yes. Is this pain manageable? Yes. Do you see where this is going? Lol.

No one here can tell you what you should do. There are several types of replacement joints discussed here. Most seem to be successful. Most seem to depend on you, the surgeon and your mindset and efforts in the rehabilitation efforts.

First go here and watch this video. https://youtu.be/RKApgiazfXw

I'm gonna catch flack for this comment. Do you trust just anyone to do this to your hand? I wouldn't. Just because my buddy rebuilds motors for Ford's and Chevy's, am I gonna let him rebuild my 1959 Ferrari motor? HECK NO! I'm gonna get the Ferrari guy. Not that my buddy couldn't do the work and that the motor would run, just that the guys that do the Ferrari motors know every little trick and know those little things that make them THE FERRARI MOTOR GUYS. LOL.

I feel that I was very blessed that I found Dr. Vo who did both my surgeries. He has done over 100 styblix implants with ZERO failures. Another person here, Wally, he found another surgeon before he found Dr. Vo. The other surgeon he looked at had a 40% failure rate on the 10 stablix joints he installed???? Sorry, that Chevy surgeon ain't working on this Ferrari. Lol.

Richard, no one can predict your best option. Can you plan on going back to your job doing what you do now as you do it now? Well I was able to do mine with changes how I went about it. Do you have this ability or option available to you? These surgeries in my case we're life changing for the better. Did I have to make changes how I do things? Yes. Would you abilities change? Yes. For how long? I say 90 days at a minimum to have fair use back. 2 years for 100% is predicted. I concur with that.

Richard, there are some things I do that make my hands hurt, one is making a fist and pounding on something. It hurts. Pushing my Jeep in the garage to re position it while working on it causes pain. Pulling hard can cause pain. Now it's bearable but it happens. Push ups suck. I don't do them. I never did them anyway so that was a bad example! Lol. Some movements will never be the same. I accept that. My life is better than it was.

Shamu .......

Having it done in March, we shall see. I have worked in it for almost 20 years so I am well aware of the + and - of surgery and possible outcomes. Always got a dnr even for a wisdom tooth lol.

Hi, my name is Jeanine. I have had CMC arthritis for about 5 years now. As many of you are familiar with I'm sure, I have done the NSAIDS, topical cream, had 5 cortisone injections in each thumb to date, wear a splint 24/7 and have come to the point where I have had enough. I have met with 2 hand surgeons, one close to where I live who is recommending the tightrope procedure and one at the Mayo Clinic in Jacksonville who is not recommending the tightrope procedure due to its failure rate and wants to do the trapeziectomy with FCR tendon "anchovy" method which he said has the highest success rate but does have minor function and strength losses. I am torn between what to do. The hand surgeon at the Mayo Clinic said that I do have severe CMC arthritis, but also ST arthritis (scaphoid and trapezium). I have been reading all of your posts and I just don't know which to pursue and who to trust to do the procedure. I am a physical therapist and have a high demand for use of my thumbs and I really don't want to lose strength nor function. I am very concerned about that. However, as some of you have mentioned, I can't even close a ziploc bag without tears. I don't care how far I have to travel to have it done, nor do I care how long or difficult the rehab is, I just want the best outcome. Can anyone make their best recommendation?

I was at the end of my tolerance with both hands, chose the tightrope with trapeziectomy for both, and have had zero issues. I wrangle 2 little grandsons, garden, quilt, paint... without issue. There is maybe a 10-20% loss of strength, but since I was at an 80% loss before surgery it is great. I am at 80% grasp strength after 8 months on the second. For those things that require strength, I learned to use the base of the thumb. My friend had her anchovy procedure 3 months before my tightrope, and was still trying to recover 1 year later. I was at 80% at 5 months, full recovery at about 7-8 months.
I found rigorous adherence to my therapy was key.
Sue

Thanks! I am going with the new stables implant and hoping I Will be
able to return to work within 2 months. Fingers crossed.
Richard H.

I work in surgery and I am terrified I may have to retire. I am having a
stables implant done March 8 as from what I have read the recovery time
On the other options is just not reasonable. I work with skeletal
dynamics products regularly and trust the person who invented the
implant. Having it done by a doc I have worked with almost 20 years will
be the first time for both of us but I can have the other procedures
done if this doesn't work as you do not lose the bone. Fingers crossed!