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.

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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@var122

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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Hi var122,

Thanks for your reply.

I have had 2 injections at 3 months intervals. Both have given me significant, yet limited relief. Both at the thumb and wrist. I have osteoarthritis at 3 junctures.

This surgeon rejects all prosthetics. I will have to educate myself on possible prosthetic with out his help. At least, he's not in a rush for the scalpel, like the last one that I consulted. He says that he has another patient that has been taking 3 months injections for some time, satisfactorily. I am grateful for the relief that I do gain, but I am not satisfied.

This appeal to you and this Mayo Clinic string of discussion is an attempt to learn what the possibilities might be. I am very reluctant to have a joint removed without having it replaced with something more than a tendon wrap.

Any direction, advice, or information that you can offer is great.

Thanks, again.

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Good morning. I'm new on this sight and am seriously considering surgery for my thumbs as they are quite painful and arthritic (as are other fingers on both hands). I've been followed by Rheum. at Mayo Rochester, and one recent visit to a local NE Wisconsin doc. He suggests surgery, but no surgeons in network in my area,so considering returning to Rochester (we visit once or twice a year; wife retired Mayo in AZ).
I find that Tramadol/Tylenol does nothing for pain in fingers and am taking Tylenol #3, a couple of times/day. I'm sick of the pain and not able to have much grip with thumbs so sore. Ultrasound guided cortisone injections did nothing but cause terrible pain 8 hours post injection that lasted for about 36 hours. The injections did nothing to alleviate pain.
I cannot use NSAID's, am 76 YO male and at wits end. Suggestions, with thanks in advance.

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I have had similar problems with my thumbs, and Naproxen was not helping at all. It was, as if the medication was hurting instead. A friend recommended tart cherry juice and turmeric pills. After few months of eating better ( more vegetables) and following friends advice my thumbs are completely pain free. I’m 68.

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@gordoapa

I have had similar problems with my thumbs, and Naproxen was not helping at all. It was, as if the medication was hurting instead. A friend recommended tart cherry juice and turmeric pills. After few months of eating better ( more vegetables) and following friends advice my thumbs are completely pain free. I’m 68.

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Thanks for the response. My x-rays indicate that I need more intervention. Best for a nice holiday.

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