For years, hand surgeons treating advanced thumb arthritis have relied on removing the arthritic trapezium to relieve pain. Replacing the damaged joint has offered another possibility, but implants have struggled to deliver reliable results.
Now, a new generation of implants is challenging that history, raising a question for surgeons: Can joint replacement finally become a dependable alternative to removing the bone?
Timothy Dooley, MD, a hand surgeon at Reno, Nev.-based Great Basin Orthopaedics, is among those willing to find out. He recently became the first surgeon in Northern Nevada to perform a thumb joint replacement using the TOUCH CMC 1 prosthesis, a cementless, dual-mobility ball-and-socket implant that has been used in Europe for roughly a decade but is relatively new to the U.S.
His interest began not with the technology itself, but with frustration over the limitations of existing procedures. After discussing those shortcomings with mentors, one suggested that the future of treating thumb carpometacarpal, or CMC, arthritis might lie in joint replacement rather than removal. As the TOUCH implant became available in the U.S., Dr. Dooley attended a training course in Las Vegas to take a closer look.
He expects the idea to face resistance.
“Implants in the thumb have never been very successful,” Dr. Dooley told Becker’s. “It’s been fraught with complications.”
Earlier generations struggled with problems that undermined confidence in replacement. Dr. Dooley believes newer designs, developed with those failures in mind, could offer greater stability. Whether they can deliver consistently better results remains to be seen.
“I think you’re going to still see people that are very skeptical, and they have every reason to be skeptical,” he said. “And then I think there’s people like me that are going to be a little bit more willing to say, ‘Hey, in the right patient, this could really work.'”
The hidden cost of removing a bone
Thumb arthritis can turn everyday tasks such as opening a jar, turning a key or writing into painful ones. When bracing, injections and other nonsurgical treatments no longer provide sufficient relief, surgeons have traditionally relied on procedures that remove the trapezium, the small bone at the base of the thumb.
The operation can be effective for pain relief, but removing the bone changes the structure of the joint. Over time, the thumb can settle into the space left behind, potentially affecting its length and mechanical strength.
For Dr. Dooley, that trade-off is one of the strongest arguments for exploring replacement.
“Maintaining the length of the thumb is really one of the biggest things that the implant will allow for,” he said. “If you can maintain the length of the thumb, then you can maintain pinch strength, you can maintain grip strength.”
Shortening can also contribute to excessive extension at the thumb’s metacarpophalangeal joint, creating additional functional problems that may eventually require another procedure. A replacement designed to preserve the joint’s structure could potentially avoid some of those complications while maintaining movement and strength.
Unlike traditional procedures that remove the trapezium, joint replacement aims to preserve the thumb’s anatomy and function. The distinction is compelling. Proving that it produces better long-term outcomes is another matter.
The X-ray can change everything
Despite his enthusiasm for the technology, Dr. Dooley does not view joint replacement as the inevitable next step for patients with thumb arthritis.
In fact, his first objective is often to avoid surgery entirely.
“First, we always try conservative management, so bracing or steroid injections,” he said. “Even activity modification can get some people through life without having to have any surgical intervention.”
When those measures fail, the decision becomes more complicated than choosing between an established operation and a newer implant. One of the most important considerations is whether arthritis extends beyond the thumb’s CMC joint into the adjacent scaphotrapeziotrapezoid, or STT, joint.
If imaging shows arthritis in the STT joint, replacing the CMC joint alone may leave the underlying source of pain unresolved. Those patients may instead require removal of the trapezium.
That anatomical distinction limits how broadly replacement can be offered, regardless of how successful the technology eventually becomes.
“Pathology and patient selection,” Dr. Dooley said, emphasizing the factors that will determine which patients are most likely to benefit.
It is a particularly important consideration as interest in newer implants grows. The availability of a more advanced procedure does not necessarily expand the number of patients for whom it is appropriate.
A decade of experience abroad, a new test in the U.S.
The TOUCH implant has been used in Europe for roughly a decade, but its relatively recent arrival in the U.S. means American surgeons are still evaluating its potential. Dr. Dooley believes that slower adoption has advantages.
“I think the U.S. is a little bit slower to adopt some of these techniques, which in a lot of ways protects patients, because we can learn from others’ mistakes,” he said.
For broader adoption, surgeons will want evidence of sustained pain relief, improved function and reliable implant performance without the complications that undermined earlier designs.
The question is not simply whether replacement can relieve pain, but whether preserving the joint offers meaningful advantages over established procedures.
Dr. Dooley expects adoption to vary as evidence develops, with some surgeons waiting for longer-term data and others introducing replacement to carefully selected patients.
A new option, not a new default
Dr. Dooley does not expect thumb replacement to displace traditional surgery. Instead, he sees it expanding the options available to patients who have exhausted conservative treatments and are suitable candidates based on their anatomy.
“I think personally, this is going to be a great option,” he said. “I think we’ll always have some patients that aren’t good candidates for it.”
After years of disappointing implant performance, thumb replacement has another chance to establish itself. Its future, however, may depend as much on knowing when not to use it as on proving what it can do.
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