Pyrocarbon thumb joint replacement

Posted by var122 @var122, Jan 15, 2018

I do not know anyone who has had a cmc thumb joint replacement....anyone have any insight? I am 5 days post op.

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@maplegrove

I had surgery on my thumb/wrist joint on January 8. So, I’m out 6 weeks. I still feel like I have a sprained wrist sometimes. Only take Tylenol once per day. I had a sling made from a tendon and another string attached to stabalize the Thumb so not a replacement. They said I was bone on bone and arthritic. I have been an artist and will continue hopefully.

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Hello!
That was one of the 3 options I was given also.
I didn't like the drawbacks of that surgery after reviewing my options.
My goals for my surgery were:
1) complete range of motion
2) keep dexterity
3) keep arm strength
4) have a fully functional joint as close to my original prior to all the arthritis.
Since I haven't been able to move my thumb, I don't really have any pain, so that's good...that may be another story after March 5 lol!
Mine was bone on bone too 🙁
Are you starting any therapy yet?

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@maplegrove

I had surgery on my thumb/wrist joint on January 8. So, I’m out 6 weeks. I still feel like I have a sprained wrist sometimes. Only take Tylenol once per day. I had a sling made from a tendon and another string attached to stabalize the Thumb so not a replacement. They said I was bone on bone and arthritic. I have been an artist and will continue hopefully.

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Hi, I'm intrigued by your post. You said you had bone on bone osteoarthritis and they used tendons to stabilize the thumb? My left thumb does this thing where is i am doing just normal stuff like housework or whatever, it feels like it tries to dislocates and causes a 10 of 10 have to stop, hold it and say ouch pain. Then it is sore for days. They gave me a splint to wear to immobilize the thumb that helps a bit but i cannot work with it on. I was told that my surgeon would not do a replacement, but would use some kind of peg? insert? can't remember just know it was not a replacement. He said i had severe osteoarthritis and could see that my wrist area is deformed. If i take off my watch, which i hardly ever do, it does look a little strange. Basically i just avoid using the thumb. They prescribed OT but it is hard to find that in network in my location. Maybe once i finish PT for my 2nd TKA (18 days ago), i will have the time to check into it.

May i ask where you went to have the procedure done and what it is called? Were other options offered?

Hope you are all healed and functional soon.

Blessings

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Hello Nancy, it sounds like you have instability in your CMC joint. I live in northern Wisconsin and had my procedure performed at the Marshfield Clinic. It is called a pyrolytic carbon implant of the CMC joint. It does look like a peg. There are numerous videos on Youtube for this procedure. The Mayo Clinic offers this procedure but my clinic was more convenient for me and I knew my surgeon already.
Well, I just had thumb #2 done 3 days ago. I have a pain pump and am in zero pain at least for one more day when the pump gets removed by my wife. O.T. is not going to solve your instability if you have biomechanical issues with cartilage and bone deficits. Xrays confirmed my specific problem and based on surrounding bone structures, I was a good candidate for this procedure. I am an active 59-year-old male who refused to settle for the barbaric LRTI method or fusion of the joint, although, those two options have been around forever.
My thumb was NOT in need of stabilization and NO tendons were used. I was offered a fusion of the joint or LRTI arthroplasty by the local orthopedists. I refused both of those options. The words joint replacement are probably misused. An implant is more appropriate and to the point. I would point out that the fusion option would stabilize the joint from dislocation, but the range of motion would be diminished(but it is probably already diminished from protective use).
Sacrifice is the key word here. I had to travel 150 miles one way to have this procedure performed by a specialist I personally researched and tracked down. There is limited specialization in northern Wisconsin so I had to travel. Getting a motel before and or after is almost a requirement. I, of course, needed a driver/caregiver for after surgery.

Best wishes moving forward.

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@stoney

Hello Nancy, it sounds like you have instability in your CMC joint. I live in northern Wisconsin and had my procedure performed at the Marshfield Clinic. It is called a pyrolytic carbon implant of the CMC joint. It does look like a peg. There are numerous videos on Youtube for this procedure. The Mayo Clinic offers this procedure but my clinic was more convenient for me and I knew my surgeon already.
Well, I just had thumb #2 done 3 days ago. I have a pain pump and am in zero pain at least for one more day when the pump gets removed by my wife. O.T. is not going to solve your instability if you have biomechanical issues with cartilage and bone deficits. Xrays confirmed my specific problem and based on surrounding bone structures, I was a good candidate for this procedure. I am an active 59-year-old male who refused to settle for the barbaric LRTI method or fusion of the joint, although, those two options have been around forever.
My thumb was NOT in need of stabilization and NO tendons were used. I was offered a fusion of the joint or LRTI arthroplasty by the local orthopedists. I refused both of those options. The words joint replacement are probably misused. An implant is more appropriate and to the point. I would point out that the fusion option would stabilize the joint from dislocation, but the range of motion would be diminished(but it is probably already diminished from protective use).
Sacrifice is the key word here. I had to travel 150 miles one way to have this procedure performed by a specialist I personally researched and tracked down. There is limited specialization in northern Wisconsin so I had to travel. Getting a motel before and or after is almost a requirement. I, of course, needed a driver/caregiver for after surgery.

Best wishes moving forward.

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Hi Stoney,
Thanks for sharing.

So when my thumb feels like it is trying to dislocate, it probably is. I could not find the original x-ray back in the day when i just had osteoarthritis in the thumb joint. I found this from 2016

FINDINGS: No acute fracture or subluxation. Severe first
carpometacarpal degenerative joint disease with joint space loss,
osteophytes, and subchondral cysts. Mild first metacarpophalangeal
and interphalangeal degenerative joint disease. Mild triscaphe
degenerative joint disease.

IMPRESSION: Degenerative joint disease is most advanced at first
carpometacarpal joint.

All i know is when it is moved some certain way it feels like it is trying to dislocate (like my shoulder used to dislocate) and then is painful for days.

The surgeon who just did my two TKAs said something about that "plug" procedure. I don't know though, if yours was fixed by a specialist, then i probably should get a second opinion and referral before they go cutting on my thumb. Mayo would be my first choice. It is hard for me to get anything done; finding drivers/caregivers is more of a challenge than the surgery.

Thanks for the info. It helped.

Hope you stay pain free and have good results on #2 once the pain pump is removed.

Blessings,

n

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@nancylh
Mine was a joint replacement. The formal name is a "hemi-arthroplasty".
I started this thread. The type of implant along with other information is in this thread with links to click for education 🙂
I had my joint replacement at Mayo Clinic in Rochester by Dr. Elhassen.
I put my 1st post-op xrays up here for you to see. Basically, they cut the end of my thumb bone off (cmc joint), made a hole into the center of the bone for the stem to be inserted into the thumb. Then, for the articulating surface, they burred a conical area for the "ball" part of the new joint to ride in....

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@var122

@nancylh
Mine was a joint replacement. The formal name is a "hemi-arthroplasty".
I started this thread. The type of implant along with other information is in this thread with links to click for education 🙂
I had my joint replacement at Mayo Clinic in Rochester by Dr. Elhassen.
I put my 1st post-op xrays up here for you to see. Basically, they cut the end of my thumb bone off (cmc joint), made a hole into the center of the bone for the stem to be inserted into the thumb. Then, for the articulating surface, they burred a conical area for the "ball" part of the new joint to ride in....

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Hi var122, I viewed a blown up version of your rays. I wonder how an implant would look different? I guess i will have to make an appt. a the Mayo after June and get a second opinion of what is wrong with my thumb and what my options are. Be blessed in your physical therapy. It will go well. PT hurts, but it helps. Thanks for sharing your experience. That helps. n

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You are looking at the implant in my thumb 🙂

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It's my 2nd one. I too am recently post-op (4 days). I kept notes from my first op so I know what to expect. Pain pump has been my best friend. I've got a compassionate supply of oxy but have not had to use them due to the bullseye expertise of my anesthesiologist's aim of the nerve block/pain pump. I type one-handed and slow, but if you have specific questions, feel free to contact me.

i

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Howdy Folks. I just got in on this string today, st. Patty's 2018. I am having problems with arthritis in my thumb and wrist right now I am getting steroid injections about every 3 months which help some but not as much as I would like. The surgeon I'm seeing does not recommend implants but prefers to do the tendon wrap. I get the heebie-jeebies just thinking about the possibility of my thumb migrating into my palm without there being an actual joint. So I guess my question after all this rattling is I don't know of any physicians near Denver that deal in these implants. It sounds like there's a lot of pain involved for me to have it done so far from my home in Wyoming? Any hints on finding physicians near Denver that are veterans in this procedure? Thanks for your consideration.

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Hello @bagus
Every 3 month steroid injection sounds excessive. How long have you been doing that? Too many injection erodes the joint quicker 🙁
If you are interested in an implant (NOT a silastic implant), I would ask your surgeon for a referral to someone that does them.
Personally, I went with the implant due to my age & what I do for a living. Everybody situation is different & perhaps a tendon ball/wrap would be sufficient for you. I do think it's worth checking out all possible ways of surgical intervention so that you are well informed on the pros & cons of each procedure.
I'll see if I can search out a potential surgeon from my surgeon in the Denver area.... My guy is a professor of hand. microsurgery orthopedics at Mayo Rochester (Dr. Elhassan), so he trains a lot of surgeons himself....

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