About eight years ago my hands started aching. The pain was for the most part concentrated in my thumb area. Sometimes they would ache upon waking and other times they ached all throughout the day. For the most part I just tried to ignore the pain and take aspirin when it got really bad. But then I started having problems opening jar lids and performing other tasks that involve pinch and grip strength to the point where I thought I should consult a doctor.
In 2013 I scheduled an appointment with Dr. K, the orthopedic physician who successfully performed laser surgery on my torn rotator cuff in 2002. His specialties include the hand and wrist and he is very nice, a super good listener and as I later found out an excellent surgeon. He took a series of x-rays and told me I had arthritis in my carpometacarpal (CMC) joint of both hands. The CMC joint, named for the bones that make up the base joint of the thumb - the trapezium, one of the small carpal bones of the wrist, and the metacarpal or long bone of the thumb - the carpometacarpal (CMC) joint is the most common site for arthritis in the hand and it predominately effects women in the middle age range. In the most common form of arthritis, osteoarthritis or degenerative joint disease, the cartilage that covers and protects the joints, wears out. Without the protective cartilage, the bones in the joint grind against one another wearing the joint down and causing pain and instability. Dr. K's suggestion at that time was to treat the symptom (pain) with cortisone injections. Since then I have had two injections per year on each hand. He told me that the injections would work for awhile and that eventually I would need a surgical procedure called tendon interposition arthroplasty (TIA) aka the "anchovy" procedure, stating that this problem does not go away. During TIA the arthritic bone that your thumb rests on (the trapezium) is removed. A small cut is made in the forearm to release a tendon, which is moved to the base of the thumb to fill in the area from which the trapezium bone was removed. So now instead of your thumb resting on a hard piece of arthritic bone (which is painful), it rests on a soft tendon pillow. A small suture anchor is placed into a thumb bone. It’s like a small harpoon with stitches on it to hold everything together. My job for the past 16 years has required me to do a moderate amount of computer work. My previous job for 10 years as a studio photographer required use of my hands all day holding a remote control to the camera and shutter release. All my hobbies- photography, canoeing, gardening, knitting and spinning have required extensive use of my hands. CMC joint issues are also hereditary. So although I thought I was too young for this ailment to be presenting itself I wasn't surprised. For those of you who did not know this mom had the TIA procedure done about ten years ago and she recommended that I not have it done because she was very unhappy about the results. Yes her pain went away but it left her with no pinch and grip strength and a shortened thumb.
In February 2015 I called and asked for another appointment with Dr. K to get cortisone shots. My pain levels were at an all time high and my hands were swollen. The scheduler told me that nurse practitioner was handling his follow up patients and she asked me if that would be alright. I said yes. I have known his nurse practitioner, N. K since I had my shoulder repaired and she is also an Otterbein grad. I met with her and we talked in depth about the worsening of pain in my hands and the causes and treatments for my pain. She also suggested taking another set of x-rays to see if anything had changed. When the x-rays were done she came back with Dr. K and they told me that my osteoarthritis in both CMC joints had progressed to severe and that now the joints were bone on bone. He also said that the treatment options were the same-cortisone until I could no longer stand the pain and then TIA surgery. I thanked them for their time and told them I would think about the surgery (knowing fully well that I was not about to do it at this time) and would like to have another cortisone shot in each joint to tide me over. Cortisone, by the way, can safely be used 3-4 times a year contrary to past belief that it was "bad for you". I've had three doctors in unrelated practices (one of whom was the Medical Director for the Columbus Blue Jackets professional hockey team tell me this. Research this on your own if you disagree. I went home and looked up the TIA on YouTube and discussed it with Andrew. He felt that I should do something about the issue now while I am still relatively young but was also concerned about the recommended procedure since mom had advised me against it and he just didn't think taking a bone out of the hand could be a good thing in the long run. I concurred and resolved to find another treatment.
I then began an internet search for an alternative. I thought surely that if they could replace a hip, knee, and shoulder joint that they could replace a thumb joint. My search turned up one replacement option manufactured by a company called BioPro. http://www.bioproimplants.com/biopro-modular-thumb-implant/. I called BioPro and talked to one of their customer service representatives about the BioPro Modular Thumb Implant. It's made of cobalt. I inquired about the availability of a study on success rate, finding a surgeon in my area and whether insurances were covering the procedure. The rep pointed me in the direction of a study which I later read and found that the success rate of 145 patients (in the research world this is an adequately sized test group so that you can be somewhat confident that the results are accurate) in the study was 94% . She told me there were 4 surgeons in Ohio. And yes insurances were covering the procedure as it is done on an outpatient basis. I called each of the recommended doctors offices. Two of the offices were not forthcoming with information (or user friendly) nor would they say whether they were using the BioPro Implant with any success, the third physician was deceased and the fourth physician's office did not return my call and after a week of waiting I concluded that their customer service was substandard so they were out. (I have a zero tolerance level for medical support staff that isn't ultra professional and since I'm paying the bill I feel I have that right). All of the physicians offices that I called suggested TIA surgery like it was the best thing to ever happen to thumb joint pain. I guess they didn't get that if I wanted that surgery I wouldn't have asked about the BioPro implant (not to mention that if I was going to have that surgery there is no one other than Dr. K, my own doctor that I have known for years, that I would want to perform the operation). Apparently TIA is the "gold standard" procedure that has been used on ailing thumb joints since the 1980's. Research on TIA revealed that people report satisfaction with the surgery because they are mostly elderly and inactive and they just want to be out of pain and don't care about preserving pinch and grip strength. I called BioPro back and asked for the names of some other doctors in surrounding states. The rep was very helpful and it turns out that she had both of her thumb joints replaced with BioPro implants by Dr. Louis Habryl in Grayling, Michigan, who invented the implant, and she said couldn't be more pleased with the results. She suggested I contact them for a phone consult and consider going to Gaylord to have the surgery. She told me Dr. Habryl had successfully done over 350+ of the surgeries. So I followed her advise and I called his office and talked with his surgical assistant Laurie. I explained my medical history and recent diagnosis and then told her I was interested in the BioPro implants but that we lived 400 miles from Gaylord and wondered if I could send my medical records to get an opinion as to whether I was a candidate for this surgery. She immediately said yes and told me everything that they would need. She also said they had patients from all over the U.S. come to Dr. Habryl for treatment. I asked her a slew of questions ranging from what could cause the surgery to fail, what are my options if it does, all the way through why aren't more physicians doing this surgery. She enthusiastically gave me a satisfactory answer to all my questions and patiently discussed the procedure for about a half an hour on the phone. About three weeks later, after Dr. Habryls office had received my medical records Laurie called to tell me that the doc had looked at my x-rays and that I was a candidate for the surgery. I will have my right hand done the first week of May as soon as spring term at school is over. I feel very good about this decision and have high hopes that it will restore use of my thumb and eliminate my pain. I guess in a way I am also taking a leap of faith in selecting the lesser known surgery. The pluses to this procedure are: no invasive tissue disruption, one small 3 cm incision in the hand instead of one incision in the arm and one in the hand, and not having the metacarpal bone in my hand removed which occur with with the TIA procedure; preservation of pinch and grip strength, and alternate treatment option (TIA as above) if the surgery fails. I will be in a cast for 4 weeks and will then rehab and be good to go 3 months out from the surgery. My follow up care will be handled where we reside by my own Dr. K. The plans are to do the left hand in December while the students are also on break from school. The left won't be as much of a challenge for me to work around since I am right handed. This is my story. I am sharing it because I want others to be educated that this treatment is available. I think many times patients just accept what their doctor says as gospel when there are other options available. And it is not my intention to criticize the doctors as I think many times they are just telling the patient what is in their scope of knowledge and practice and they might not be aware of alternatives. For some people that is fine with them. For my own personal medical care I prefer to do some homework prior to treatment. Just think about the advances in the medical field in our lifetime. In the 70's we were in awe of Steve Austin, The Bionic Man. We thought the show was science fiction/fantasy. Now we have some of options similar to those depicted in the television show available to improve the quality of our own lives.
For more information:
The implant
Area and size of incision
Watch an animated version of the surgery here:
Here is the info on the implant
Here are the studies I found
Harve Bennett: Steve Austin, astronaut. A man barely alive.
Oscar Goldman: Gentlemen, we can rebuild him. We have the technology. We have the capability to make the world's first bionic man. Steve Austin will be that man. Better than he was before. Better... stronger... faster.