Philadelphia-based Rothman Orthopaedics has performed the first U.S. case of a dual mobility total joint replacement for the thumb’s basal joint — a milestone that could redefine how surgeons treat one of the most common forms of hand arthritis.
For decades, thumb basal joint arthritis has been treated using a surgical technique dating back to 1949 which relieves pain but often leaves patients with weakness, deformity and a long recovery period, Rothman said in an email statement to Becker’s.
“It started from a position of just wanting to do better,” said Richard Tosti, MD, orthopedic surgeon. “The techniques that are most commonly used in North America right now date back to 1949. What in medicine has that kind of longevity?”
Dr. Tosti said the conventional approach — removing the trapezium bone to prevent bone-on-bone grinding — can work but comes at a cost.
“It takes a while to recover because it’s a lot of surgery. You’re basically dissecting all around a certain bone or more or less ripping it out of the wrist,” he said. “It’s a pretty violent operation.”
His interest in advancing thumb arthroplasty led him to study the success of dual mobility implants in France and Belgium, where the technology has shown survival rates above 95% at five to 10 years.
While early implant designs in the U.S. faltered decades ago, European surgeons continued refining them — moving from cemented to uncemented, press-fit devices with advanced plasma-sprayed surfaces that promote bone growth, Dr. Tosti said.
“A couple of us went over to Belgium and France last winter,” Dr. Tosti said. “The first patient we saw reached over, grabbed a chair with the operative thumb, pulled the chair out and sat down. I had never seen anybody whose resection could do anything remotely like that before. That grabbed my attention.”
After months of research and preparation, the technology received FDA clearance in July, and Dr. Tosti performed the first procedures in October at Rothman’s Physician Care Surgical Hospital in Limerick, Pa.
Since then, early outcomes have been striking. Dr. Tosti said patients experience less pain and greater motion with the dual mobility implant compared to traditional bone removal.
“Although it doesn’t sound like it, it’s actually less surgery,” he said. “You’re only resecting about five millimeters of bone on one side, and then there’s an implant that takes its place. So pain is less. The range of motion is better, the muscles have a better line of pull — they’re able to oppose the thumb and grab things right away.”
He added that the procedure also corrects deformities common in severe arthritis.
“People end up with this zigzag deformity,” he said. “With the implant, when you restore the length, the deformity goes away. I’ve had patients who’ve had the old procedure on one hand and the new on the other — it looks like two different people.”
Introducing the new technique required painstaking preparation. Dr. Tosti said he reviewed videos from European colleagues “maybe 100 times” before performing the first case.
“You have to pay attention to every single detail,” he said. “Some of it was visualization and rehearsal, other parts were good pre-op templating. You measure once, cut once, place the implant once. Even in the first cases, none were over an hour.”
Dr. Tosti believes the dual mobility design could chart a new course for thumb surgery, one similar to the evolution of total hip replacement.
“I think this will end up taking a trajectory like total hip replacement,” he said. “Initially, they just cut off the head of the femur and let people walk on it. Then it evolved into something with great longevity that helps a lot of people. I think this is another step in that evolution — it’s just been slower for hand surgery.”
He expects wider adoption in the coming years. “I think it will probably eventually become the standard of care,” he said. “But that’s still to be seen.”
Alongside the clinical work, Dr. Tosti and his colleagues are developing a review article for The Journal of Hand Surgery to summarize the European data and guide future adopters.
“We wanted to have an article where all the major points are around one thing — somebody could pick this up and read it and be comfortable with the background,” he said. “There are also research projects we’re looking into to build on the European literature.”
