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Old 04-27-2011, 03:23 AM   #1
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Basal Joint Arthoplasty... Anyone have??

I am considering having this done to my right hand. Anyone have it done? Can you tell me if it was successful and worth it? If you know what type of surgery you had, please tell me. It appears there are a few types. Has it lasted long term?? Any unexpected problems?

Thanks.

 
Old 04-30-2011, 01:58 AM   #2
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Re: Basal Joint Arthoplasty..Anyone have??

Hi Scanmike,
Due to all loss of cartilage in between the bones of my left thumb,
I am due to have Arthroplasty & Ligamentoplasty on the thumb & wrist of my left hand on May.2nd. I have heard that it is a very successfull operation. Arm will be in a hard cast for 1 month, followed by a splint. I will be having pysio for as long as I need,starting 1 week after removal of hard cast.

 
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Old 05-06-2011, 10:26 AM   #3
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Re: Basal Joint Arthoplasty..Anyone have??

Hello,

I have had the surgery (7/15/2010) where they take the tendon from your arm and replace the basal joint with the tendon. I have had the arthritis for many years and finally just couldn't stand the day to day grinding pain. The surgery went well, was out of the hospital before lunch time. I did have a nerve block which kept me from feeling anything from my shoulder down, which was a little unsettling. this was on my left, non dominant hand. It was painful at first but they tend to give you enough meds to keep from feeling it too bad. I had a hard cast on but only for a short time because it was rubbing on my incision, so they moved me to a splint early. The problem that I have encountered and this is definitely NOT typical, is that the joint above the replacement has locked up. And because I had been trying to use it, the first joint has taken up all the work and now has arthirtis as well. In order to unlock that joint, I am going to need to have additional surgery to do one of several things, I can leave it the way it is, becuase I can use it, just not as well as before, or fuse the joint at a better angle, or the other option, which is more likely what I will do, is to have additional surgery to free up the joint, then extensive PT afterwards. That being said, would I have the initial surgery again, in a heart beat. No more of the grinding, hateful pain. Just a suggestion, there are many informative threads that have closed that people have talked about what surgery and how it went. Check out the following, 'CMC Joint Arthoplasty' or 'Basal joint surgery treatment...' for some good descussions.

 
Old 05-06-2011, 02:32 PM   #4
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Re: Basal Joint Arthoplasty..Anyone have??

Thanks so much for responding. I am going for my third opinion on Monday and will ask way more questions now that I have read up on it. I did check out the other posts and it did both give me positive hope and also scared me at the length of time involved in regaining use of the hand. I have pain, wear a soft, over the counter splint, sometimes on both hands. I am an occupational therapist and am worried about long term function. I was planning on having it done over the summer, since I work for the school system. I have to admit, I am scared to death. While I have pain, and have for years, I still can use the hand. I swear the pain seems worse since I went to the surgeons. I think the stress of what to do has exacerbated it. Since, as you read, both surgeons disagree on what to do as far as tendon replacement, I got even more stressed. The FCR tendon from your own arm is apparently much more common. I did read a few people's posts who used donor. They did seem to heal quite fast. Not sure what to do, so will see what Monday bring. Thanks again!!

 
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Old 05-06-2011, 02:34 PM   #5
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Re: Basal Joint Arthoplasty..Anyone have??

Just read your post and not sure why I never saw it. By now you have had your surgery. I hope it went well. When you are up to it, let me know how it turned out. Good luck!

Denise

 
Old 05-06-2011, 09:33 PM   #6
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Re: Basal Joint Arthoplasty..Anyone have??

Quote:
Originally Posted by scanmike View Post
Thanks so much for responding. I am going for my third opinion on Monday and will ask way more questions now that I have read up on it. I did check out the other posts and it did both give me positive hope and also scared me at the length of time involved in regaining use of the hand. I have pain, wear a soft, over the counter splint, sometimes on both hands. I am an occupational therapist and am worried about long term function. I was planning on having it done over the summer, since I work for the school system. I have to admit, I am scared to death. While I have pain, and have for years, I still can use the hand. I swear the pain seems worse since I went to the surgeons. I think the stress of what to do has exacerbated it. Since, as you read, both surgeons disagree on what to do as far as tendon replacement, I got even more stressed. The FCR tendon from your own arm is apparently much more common. I did read a few people's posts who used donor. They did seem to heal quite fast. Not sure what to do, so will see what Monday bring. Thanks again!!
hello denise,
i am sorry you in such a state, of pain and confusion. i will try to give you as much info as i can here;
i had my surgery 2nd may.2011. with full anaestetic which my hand surgeon recommended. it took about 1. 1/2 hours. he suggested i stay the night in hospital in order to get a cocktail of pain killers. i am pleased i listened to him as i was pain free after the surgery, due to his excellent work and the cocktail.
the surgery he performed is called, arthroplasty cm1. he cut a piece of the tendon from the left wrist and wrapped it round the bones in the thumb where the cartilage was missing. on the letter he gave me is written,---- grind test---- and--- abd.l--- sorry i cant tell you what that means.
i have 1/4 cast only hard cast in the ball of my left hand, with the original bandage wrapped around the entire hand and wrist. my fingers are free, left thumb is covered and sticks out at the nail. i was told to keep my hand/arm raised at all times. i do this by wearing a sling during the day and when resting or sleeping, i rest my hand, on my elbow, against 4 pillows which are on top of eachother. weird as it sounds, this is really possible.
i am in no pain whatsoever. when i have the throbbing feeling i place an ice pack in its cover, on the wrist and take a pain killer.of course when i raise my hand, i do feel discomfort.
my surgeon told me that he will remove the 1/4 cast/bandage tomorrow for a splint. i am not sure what kind of splint. am also not sure about the stitches, if he will remove them or if they are self-desolving ones.
i will let you know here as soon as i can. before the operation,
i was told by my osteopath to wear the softcast as little as possible so as not to weaken the muscles. muscles heal better when they are stronger. my surgeon told me only to wear the soft cast when in pain. i only wore the soft cast outdoors as i was afraid of getting kocked.
i tried to do as much as i could with my left hand, including driving, automatic gear, cooking, etc. i am retired.
yes, stress does make the pain worse. an ice pack helps after surgery whislt placing my hand on a hot water bottle helped the pain before surgery.
denise, every person responds differently to surgery. i was told that it could take up to 4-6 months to get the use of my hand back to its original state.
it is off great importance for you to trust your surgeon and to know exactly what you are going to go through. please try very hard not to panic, it makes your situation worse.
if you need to get a 4th opinion, go for it. only agree to surgery when you feel 100 per cent sure of yourself and your surgeon. you also need to give yourself time, to think, discuss and decide.
i am online every day, i am willing to give you as much feedback as i can, so please use this board for any question and your fears. as the saying goes, 2 heads are better than one.
good luck for your appointment on monday. i will post more tomorrow, sunday, after i see my surgeon.
haydena.

 
Old 05-07-2011, 05:26 AM   #7
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Re: Basal Joint Arthoplasty..Anyone have??

Hi Haydena,

Thank you so much for all the info. I posted awhile back and didn't get any responses. I really do appreciate everything you said. I agree that I need to trust my surgeon. AFter the first two opinions, I got so panicked. Mostly because they disagreed on how to do it and secondly because it was my decision to make. Would I end up worse? Should I just wait? What if I picked the wrong dr.? etc, etc. I decided to get my head off the internet and stop reading medical journal articles. My husband told me to put it away for awhile. On Monday, I go for the third opinion. I feel more empowered this time and have most of the questions I need to ask since I am better informed from all of you here what to expect. I am 54 years old and not in alot of pain, though I have good pain tolerance. My thumbs are still functional, as I read that alot of people here were unable to use their hands. I almost wish the decision was made for me or that the pain was so bad, that anything less would be a blessing. However, I do know that it's getting worse (stage 4 left non dominant, stage 3 right dominant) and I fear that if I don't do something I will not have good use of my hands as I get older. The pain is tolerable. I have spurrs on the right all over the bone they remove, so that causes a sharp pain daily. Tks for the headsup about the soft splints. I will do my right first since it's my dominant hand and hurts me more due to the spurs. How old are you (if you don't mind answering) and how long have you had it?. Also, how much pain were you in?? I appreciate your help.

 
Old 05-07-2011, 07:54 AM   #8
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Re: Basal Joint Arthoplasty..Anyone have??

Hi again Denise,
from what i understood about this operation was; when the cartilage in between the thumb bones is lost, nothing but an op will help. we cannot go to a pharmacy to buy cartilage.
when my surgeon suggested operation, my reply was, yes, straight away. i did ask my osteopath, who told me to go ahead for the above reasons.
i am an active 63 year old. prior to the op i suffered pain in the thumb, fingers, wrist and forearm for 2 years. the last 6 months the pain got worse. about 3 months ago i asked for both hands to be xrayed. i took the answers to my surgeon/orthopedic hand surgeon who showed me where the cartilage in the left thumb, between the 2 bones, was missing.
my common sense told me that i needed to go through the op, no matter how hard it was to recover. you see your pain will not get better, only worse.

i am willing to ask my surgeon, who is also a professor, if he knowsof a good hand surgeon for you. are you in new york city?

i do sympathize with your confusion and your husband is 100 per correct. of course you need to have your right hand done first, then at a later stage, the left hand.
surgery is not an easy decision and as i wrote previously, you just need to trust the surgeon and yourself.
i would also suggest you buy a homeopathic cream called arnica which is used for bruising and swelling. you can apply it every 2 hours as long as you dont apply it to an open wound.
i swear by this cream.
hang in there denise and i'm rooting for you.dont forget to reply to my question pl.

haydena

 
Old 05-07-2011, 10:56 AM   #9
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Re: Basal Joint Arthoplasty..Anyone have??

Hi again,

Yes, I am in NYC area. I went to a Dr. Raskin, who may not be in my network, but have to see what's up with that. He's the one with the tendon from your own arm. The next guy is a Dr. Poltasch, also in NYC. If you don't mind asking your profesor, I am curious to see who he would recommend. I swear by now, I know all their names! I will definitely look into the cream. Have a Happy Mother's Day and I will probably have more questions for you, especially after Monday.

Denise

 
Old 05-07-2011, 01:25 PM   #10
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Re: Basal Joint Arthoplasty..Anyone have??

hi denise,
i read up on the 2 doctors you named. i re-read all your posts again and have had a good think here.
if i was in your situation, i would prefer to have my own tendon used rather than something else, because my tendon would not be foreign to my body.
poltasch works in a clinic with other orthopeds whereas raskin works alone.
i will ask my surgeon for the best in nyc.
in the meantime i ask you to please try to get your muscles ready. meaning try to do some light excercises with your arms and hands, shoulders and neck. try not to be stiff, try to relax. i understand you are petrified now. what you need is to loosen up. this will help your mind aswell.
dont forget you will have physio as soon as your doctor thinks you are ready for it.
you will be ok, i know you will be.
good luck for monday and happy mothers day to you too.

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Old 05-07-2011, 01:41 PM   #11
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Re: Basal Joint Arthoplasty..Anyone have??

Hi,

Just to clarify, both those Dr.'s use your own tendon. The one who doesn't is in Brooklyn and does his surgery in NJ. I actually was really impressed with his hands on approach and he came also with a good referral from my friend who works in a hand therapy clinic. But he uses the donor...his name is Dr. Thomas Wolosyzn. He used a flouroscope machine to look at my hands cause he wanted to see the bones in action.He was aware of all the other procedures but said he doesn't like to take your tendon because it may impact the wrist and hand motion. Dr. Polatsch works with Dr. Melone? who is a top dr. But I liked all of Polatsch's reviews, and he takes my insurance. One who I didn't choose for my third opinion was Dr. Botwinick, who says on his website that he specializes in this surgery, but opinions said he didn't give you much time. Supposedly, Raskin does good work, but not sure if I am covered by him. On another note, I planted my flowerboxes today and didn't use my splints. Those damn spurs hurt, but it felt good to do it. How are you doing?? Also, Raskin said he uses regional anesthesia like a colonoscopy and numbs your arm. Woloszyn said general anesthesia. Another difference. I shall see what Polatsch says.

 
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Old 05-07-2011, 02:12 PM   #12
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Re: Basal Joint Arthoplasty..Anyone have??

hi denise,
i had general anesthesia. my gut feeling is poltasch.
congrats for planting your flower boxes;sorry about the painfull spurs. enjoy the flowers. i was able to wash my hair alone earlier, with one hand. at the end of all of this we will be able to write a book, "how to succeed as a one handed woman" lol.
my wrist has started to throb now, as i reach for my ice pack, i say goodnight to you.
untill tomorrow.
haydena.

 
Old 05-09-2011, 04:20 AM   #13
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Re: Basal Joint Arthoplasty..Anyone have??

Hi Haydena,

How long are you post op now? Do you know when you can start moving your hand? Trying to get a time line of how long I can expect NOT to use my hand. How are you otherwise? Can you get dressed, move around and get around? I will definitely look up that posting. I will let you know how it goes today. Talk to you later!

 
Old 05-09-2011, 07:51 AM   #14
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Re: Basal Joint Arthoplasty..Anyone have??

hi denise,
it is exactly 1 week today since i had my operation.
i can move my hand since yesterday when the hard plaster ball and bandage was removed.
i am not allowed and cannot bend my thumb inwards towards my palm.i was instructed to bend my fingers once hourly. i can only bend the tip of my thumb slightly as it is incased in micro plastic covered by velcro. i am able to grip a tissue with my 4 fingers even lightly scratch my face.
after 6 weeks this splint will be removed when i will start physio. as i have told you, everyone has their own recovery pace. reading the thread i gave you tells you exactly what you need to know as 1 of the ladies who had this op is now 1 year post op. her nickname is dajo. her posts gave me the strength to continue. chiacat is another very helpful lady.
i am able to dress myself alone. i wear a sports bra which is elasticated without closures.
its easy to pull a large t-shirt over my head, putting left arm in left sleeve first, etc.
i wear easy fitting elasticated burmudas or trousers and slip on comfortable sandals.
shoes that close with velcro are available, i wear them (flat) when i go out) i bought 2 sleeveless light sweaters with 2 large buttons in front.
yes i can move around easily. i cannot drive. seeing that i am retired i guess its easier.
showering is no hardship for me; i wear a light rubber sleeve specially made for keeping the arm dry.i stand on a rubber mat as not to slip whilst showering. i washed my hair with ease, with my right hand.
only things i am unable to do is cook a meal, change the sheets on a bed. wash the stone floors, we have here. lift anthing except a tissue, kleenex.
i'm not sure if i told you that at the moment i am living in israel.
any questions- please ask.
haydena.

 
Old 05-09-2011, 04:37 PM   #15
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Re: Basal Joint Arthoplasty..Anyone have??

Hi Haydena,

I went to see Polatsch, whom I liked alot. I told him my fears and he was calm and had a quiet demeanor. We chatted about the various techniques when I told him I read an article he had written years ago. He laughed and said he probaby wouldn't write half of it now and not to be concerned about the procedure. He did say 90% do it with your own tendon as it has a proven track record of good success. But he didn't put othr techniques down. Took xrays and said in agreement with Raskin that my left is worse, but both are stage 4 and have spurs. That being said he said I should try a cortisone shot first and to wait till I am in more pain. He said it's not an easy operation, which I appreciated. He was honest and said it's very painful, but some people find it okay and some painful. But since my function is okay, the pain may retreat for awhile, like it's been doing. He would rather me wait so that I feel it was worth it. I don'thave intolerable pain now and I am not dropping anything. He said if I don't have pain and I feel some pain afterwards (5% have some discomfort) then I may question why I did it. By waiting (which there is no time frame..meaning I can get this done without fear of more damange thru waiting) until I feel alot of discomfort, I would feel the difference more and feel it was worth it. He said not sure why the other surgeons didn't offer trying cortisone, but made a joke "when you go into a hairsalon everyone gets a trim, it's not the same for surgery" and especially this type. So I tried the cortisone and let's see if it buys me time. I think I can wait till next summer if need be and this way I can really see how much it does hurt me. In the past, I would have good months and then bad. Not sure how much my anxiety made things worse. My daughter thinks I shouldn't wait, but I told her maybe I will be more mentally prepared next year. I definitely would use him. Very knowledgable and patient. I am glad I went because I feel it was the right decision and that I will know when it's time. I am no longer afraid and had he said it's time...I would have trusted him. I liked his forthright honesty. Plus he takes my insurance! Keep me posted on how you do. This way, next year I will really now how long it takes and plan the surgery appropriately. I was definitely rushing this one in time for summer vacation. Oh yeah, he said 4 weeks in a cast and then he takes the pin out. Regional anesthesia..I suspect like a colonoscopy. BYW, he also said "alot of basal arthritis, sees alot , all the time". He said the woman in the next room was worse than me, but only at stage 1. So I guess it's not always about the xray, but more how you feel. Keep me posted. It's been great and will be great to follow your progress.

Last edited by moderator2; 05-09-2011 at 05:06 PM.

 
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