Not everyone would want to be among the first on the operating table for a newly approved surgery, but after a decade of pain, Erika Clancy was eager and ready.
The problem has been her thumbs, those underrecognized digits that help turn a key, hold a fork, grip a steering wheel and spend the day grasping and precisely manipulating just about anything.
There isn't one injury or incident that's fueled the discomfort, but over the last 10 years, Clancy said, her arthritis has worsened. She's undergone six surgeries to repair ligaments in her hands, has worn a brace on one hand or the other for years and gets regular cortisone shots to relieve her aches.
There are surgical replacement options for thumb arthritis in the U.S., but they largely involve lengthy recoveries and don’t ensure the same mobility and strength. Clancy wasn’t interested. Then about three years ago, her doctor mentioned the possibility of a new surgery popular in Europe, one that involves a metal-and-polyethylene prosthetic thumb joint.
Clancy jumped at the chance to reduce, and hopefully eliminate, any future treatment on her hands.
“We were just kind of holding out for this one,” said the 51-year-old former teacher.
The U.S. Food and Drug Administration approved the procedure last summer, and since then, surgeons nationwide have started to offer thumb prostheses to more and more patients with arthritis. Last week, a team from UW Medicine became the first in the Pacific Northwest to perform the joint-replacement surgery.
Thumb arthritis is something we see all the time, so this is a game changer for us, said UW Medicine's Dr. Jerry Huang, a national leader on hand, wrist and elbow conditions, and the orthopedic surgeon who led the procedure.
By some estimates, about 7% of men, 15% of women and up to a third of postmenopausal women can be affected by carpometacarpal osteoarthritis, or CMC arthritis, a degenerative condition that involves cartilage wearing away at the base of the thumb.
The prosthetic surgery has been considered the gold standard for treatment in Europe for years, Huang said. In preparing for approval and rollout here, KeriMedical, the Switzerland-based manufacturer of the artificial joint, invited about 45 American surgeons to Europe last spring for training on the procedure.
Huang, who performed all of Clancy's previous hand surgeries, was one of them.
He likened the procedure to a “mini hip replacement,” and said patients should experience a quicker recovery, less pain and a wider range of motion after surgery.
“We’re all being really careful to make sure patients are doing well,” he said. “But I think for patients who are interested, … we’ll probably look at offering this as the standard of care at some point.”
On the operating table
Clancy was almost invisible under a swath of blue, all except her right hand, which was propped up on a table between the doctors and a nurse. As Huang sliced into the base of her thumb, he murmured observations to Dr. Brynn Hathaway, who sat across from him during the novel surgery last Friday.
For the next 45 minutes, in an operating room at UW Medical Center’s Roosevelt clinic, the team glided through the procedure. They started with the metacarpal, the thumb's biggest bone, where they first inserted a trial stem into the bone to confirm the fit. Then surgeons turned to her trapezium, the bone that bridges the thumb to the wrist.
Together, the two bones, along with the carpometacarpal joint, help the thumb flex, extend and rotate, essentially giving it its opposable quality.
Inside Clancy’s trapezium, surgeons implanted a metal cup, or socket.
In the final step, they swapped out the trial piece, replacing it with a titanium stem connected to a polyethylene ball, set to articulate with the socket and act as the new joint.
When fitted together, the prosthesis should restore mobility and stability, Huang said.
“What makes the thumb a bit tougher is the anatomy is much more complex,” he said. “The thumb has to move in multiple planes.”
Any movement that involves pinching and gripping relies on the thumb, which means severe arthritis can make even simple activities — like opening jars or holding a plate — extremely difficult, Huang said.
For Clancy, it means she’s on edge when shaking people’s hands, vacuuming and doing dishes.
“I’m just looking forward to not aching all the time anymore,” she said.
With the prosthetic joint in place, Huang and Hathaway sewed up Clancy’s hand with six stitches, then secured it with a strip of plaster and several layers of gauze. Shortly after, Huang stepped into a hallway outside the operating room and described the experience as “very smooth.”
“Everything went great,” Huang said with a smile. “I’m really happy with the way the surgery turned out.”
An hour later, Clancy was headed home.
A new standard
Since September, about 300 of the new prosthetic joints have been implanted in the U.S., said Brian Wood, a regional sales manager at Medartis, which fully acquired manufacturer KeriMedical last year.
Although the implant is not yet widely available in the U.S., the company’s goal is to spend the next several years training more surgeons and eventually establish the procedure as the standard of care for carpometacarpal arthritis, said Wood, who visited UW Medicine’s Roosevelt clinic Friday for the region’s first two surgeries. Clancy was up second, after a 71-year-old patient also with thumb arthritis.
When explaining why Huang was one of a few dozen U.S. physicians chosen to attend last year’s trainings in Europe, Wood pointed to his longtime expertise in hand, wrist and elbow surgery.
“He's obviously a recognized leader within his field,” Wood said. “We're happy to have him as one of our regional specialists.”
Medicare and Medicaid, and private insurers, should cover the procedure when it's determined to be medically necessary, according to UW Medicine.
This week, Clancy said she was recovering well at her Bellevue home with lots of sleep and support from her husband, two teenagers and their four rag doll cats: Beefcake, Cupcake, Mudcake and Snowflake.
She’ll be in her plaster splint for two weeks, then start physical therapy. She should avoid lifting anything heavier than 2 pounds for the first six weeks, Huang said.
In three months, she shouldn’t have any restrictions, Huang told her before she was wheeled into the operating room. How does she feel about that?
Clancy grinned and gave a thumbs-up.
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