Thumb arthritis surgery relieves pain and restores useful pinch and grip when osteoarthritis at the base of the thumb, known as rhizarthrosis or carpometacarpal (CMC) joint arthritis, no longer responds to simpler measures. This joint allows the thumb to swing across the palm and oppose the fingers, and when it wears, everyday tasks such as turning a key, opening a jar or writing can become genuinely painful. At our Harley Street practice in London, Ms Anna De Leo, a GMC-registered Consultant Plastic and Reconstructive Surgeon with the European Diploma in Hand Surgery and specialist microsurgical training, offers expert diagnosis and a stepwise plan.
Most people with base of thumb arthritis are well managed without an operation, through splints, hand therapy, joint protection and injections. When pain persists and function declines despite these measures, a range of well-established procedures, from trapeziectomy to joint replacement, can provide lasting relief.
01What Is Rhizarthrosis (Base of Thumb Arthritis)?
The base of the thumb is formed by the trapeziometacarpal joint, where the first metacarpal meets a small wrist bone called the trapezium. Its saddle shape gives the thumb its remarkable range of movement, but it also concentrates heavy forces on a small area of cartilage every time you pinch or grip. Over time, the cartilage can wear thin and roughen, the supporting ligaments loosen, and the joint becomes inflamed and unstable. This is rhizarthrosis, one of the most common forms of osteoarthritis in the hand.
Typical symptoms include:
- Aching pain at the base of the thumb, worse with use, especially pinching, twisting and gripping.
- Tenderness to pressure over the joint at the root of the thumb.
- Difficulty opening jars and bottles, turning keys, writing or lifting a kettle.
- Swelling and a prominent, “squared” appearance at the base of the thumb.
- Weakness, stiffness in the morning and, in advanced cases, the thumb collapsing into the palm with the next joint over-straightening.
Base of thumb arthritis is most common in women over 50, and hormonal factors, genetics, joint laxity, previous injury and rheumatoid or other inflammatory arthritis all play a part. Some people have striking X-ray changes with few symptoms, while others have significant pain with modest changes, so treatment is always guided by how the thumb affects your life, not by the image alone.
02Diagnosis and Non-Surgical Treatment First
Ms Anna De Leo will examine the thumb for tenderness, swelling, instability and grinding at the joint, assess pinch strength, and look at neighbouring joints. She will also look for conditions that commonly coexist or mimic thumb arthritis, including De Quervain’s tenosynovitis, trigger thumb and carpal tunnel syndrome. X-rays confirm the diagnosis and show the stage of arthritis, including whether the neighbouring joints of the trapezium are also affected, which influences the choice of any later surgery.
Non-surgical care is effective for many people and is always offered first:
- Splints: a custom thermoplastic or soft splint supports the joint during flare-ups, heavy tasks or at night.
- Hand therapy: targeted exercises strengthen the muscles that stabilise the thumb, alongside joint-protection techniques.
- Adaptive aids: jar openers, thicker pens and key turners reduce strain during everyday tasks.
- Medication: simple painkillers or anti-inflammatory gels, where suitable.
- Injections: a corticosteroid injection into the joint can provide months of relief, particularly in earlier disease. Hyaluronic acid and other regenerative injections are sometimes discussed, though the evidence for them is still developing, and expectations are set honestly.
Thumb arthritis surgery is considered when pain persists despite a good trial of these measures, sleep is disturbed, or hand function is significantly limited.
03Your Consultation on Harley Street
Your consultation takes place at 64 Harley Street in Marylebone, part of the London district that has been home to British consultative medicine since the nineteenth century. Ms De Leo sees each patient personally, with time to understand your work, hobbies and the tasks that matter most to you, whether that is gardening, playing an instrument, typing or caring for grandchildren.
She will explain the stage of your arthritis, what can be achieved without surgery, and, if an operation is appropriate, the advantages and trade-offs of each technique, including recovery time, strength and durability. If an injection is suitable, it can often be performed at the same visit, sometimes with imaging guidance.
Patients often ask about thumb arthritis surgery cost factors. Your personalised plan depends on imaging, the procedure chosen, any implant used, the anaesthetic, the facility and the length of hand therapy and splinting afterwards. These are explained openly before any decision. If you are looking for a base of thumb arthritis specialist near Marylebone or elsewhere in central London, the clinic is open every day by appointment.
04Thumb Arthritis Surgery Options
There is no single best operation for every thumb. Ms De Leo tailors the procedure to the stage of arthritis, your age, activity level and priorities. Thumb arthritis surgery is usually performed as a day case under a regional nerve block, which numbs the arm, or general anaesthesia.
Trapeziectomy
The most widely performed and longest-established procedure. The worn trapezium bone is removed, eliminating the arthritic surfaces, and the space fills with scar tissue over the following months. It may be combined with a ligament reconstruction or a tendon suspension to support the thumb. Trapeziectomy gives reliable pain relief and is suitable even when neighbouring joints are affected, but recovery of strength is gradual.
Thumb joint replacement
A small prosthetic joint replaces the worn surfaces, preserving thumb length and often allowing a faster recovery of movement and pinch strength. It is suited to selected patients with good bone quality and arthritis limited to the base joint. As with any implant, there is a risk of loosening or dislocation, and longer-term revision may occasionally be needed.
Joint fusion (arthrodesis)
The joint is fixed in a functional position so that it heals as solid bone. This provides a strong, stable thumb for younger patients doing heavy manual work, at the cost of some movement.
Joint-sparing procedures
In early disease, options such as arthroscopic debridement, ligament reconstruction, a realigning osteotomy or joint denervation may be considered.
Throughout, Ms De Leo’s microsurgical training ensures careful handling of the small sensory nerve branches and the radial artery that lie close to the joint.
The thumb does half the work of the hand; the aim of treatment is simple and practical, to let you pinch, grip and twist again without pain.
ADLSynergy · Harley Street
05Thumb Arthritis Surgery Recovery Time
Recovery after thumb arthritis surgery depends on the procedure, and patience is important: the thumb continues to improve for many months.
- First two weeks: a plaster or splint protects the thumb; keep the hand elevated and move the fingers freely. Wound review and suture removal take place at around two weeks.
- Weeks 2–6: a custom thermoplastic splint is worn, typically for four to six weeks after trapeziectomy or fusion and for a shorter period after joint replacement. Hand therapy begins to restore movement. Desk work is usually possible from two to four weeks.
- Weeks 6–12: the splint is gradually weaned; strengthening and return to driving and everyday tasks.
- 3–12 months: pinch and grip strength continue to improve, and most people find the thumb much more comfortable for daily activities.
Follow-up is arranged at our Harley Street clinic in London, and the ADLSynergy recovery team can support scar therapy, swelling management and general wellbeing during healing; you can read more about our longevity and recovery programme.
06Thumb Arthritis Surgery Risks and Realistic Results
Thumb arthritis surgery relieves pain for the large majority of patients, but results vary, and every operation carries risks. These include:
- Wound infection, bleeding or a sensitive scar.
- Irritation or injury of the superficial radial nerve branches, causing numbness or tingling over the thumb.
- Persistent aching or reduced pinch strength while recovery continues, occasionally long-term.
- Tendon irritation after trapeziectomy procedures.
- Implant loosening, wear or dislocation after joint replacement, sometimes requiring further surgery.
- Failure of the bones to unite after fusion.
- Stiffness or complex regional pain syndrome, both uncommon.
A realistic “before and after” is a thumb that no longer aches with every pinch, nights without pain, and a return to the tasks you had begun to avoid.
07Why Choose Ms Anna De Leo on Harley Street
Ms Anna De Leo holds the European Diploma in Hand Surgery, an International Master’s Degree in Reconstructive Microsurgery and a Diploma in Microsurgical Techniques, and is a Fellow of the European Board of Plastic, Reconstructive and Aesthetic Surgery. Her experience of over twenty years includes London NHS hospitals, such as Chelsea and Westminster and the Royal Free, Oxford University Hospitals, and international centres in Barcelona, Helsinki and Belo Horizonte.
As a female surgeon with a conservative philosophy, she understands how much a painful thumb can affect independence, and she always begins with the simplest effective treatment. Learn more about Ms Anna De Leo and our Harley Street practice in London, or book a consultation to discuss whether thumb arthritis surgery, or a simpler treatment, is right for you.
