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LRTI Surgery for Thumb CMC Arthritis

To help you discuss LRTI surgery as a treatment option for your thumb CMC arthritis with your orthopedic surgeon, here’s a breakdown of this surgical procedure.

What Is Thumb CMC Arthritis?

The joint located at the base of the thumb is known as the carpometacarpal (CMC) joint. The CMC is the joint most affected in thumb arthritis.

It occurs when the cartilage covering the ends of the bones in the CMC joint is worn out, causing swelling, tenderness, and pain. CMC arthritis is commonly known as arthritis of the thumb or basal joint arthritis.

What Is LRTI Surgery? 

LRTI stands for ligament reconstruction and tendon interposition. It is a surgical procedure to treat thumb CMC arthritis by removing the trapezium bone from the wrist, and smoothing out the remaining surfaces of the CMC and STT joints.

The patient may require LRTI if there is pain and discomfort at the base of the thumb during activities such as gripping, grasping or pinching. Other signs may include:

  • Tenderness, stiffness, and swelling at the base of the thumb
  • Pain that gets worse after prolonged use of the thumb
  • Enlarged and bony ("out-of-joint") appearance at the base of the thumb 
  • Limited motion of the thumb and feeling of loss of strength
  • Grinding sensation with a grating sound when moving the thumb

The major benefit of the LRTI is it can prevent the recurrence of CMC arthritis to a large extent. Other benefits include:

  • Near-complete or complete pain relief in most cases 
  • Mobility equivalent to or near to that of a healthy thumb
  • Substantial return of grip or grasp or pinch strength 
  • A better functional thumb 

How Is LRTI Surgery Performed?

The orthopedic surgeon performs LRTI according to the following procedure:

  • The orthopedic surgeon makes an incision in the forearm near the CMC joint.
  • The surgeon cuts the FCR (flexor carpi radialis) tendon in the forearm.
  •  The surgeon drills a hole in the metacarpal bone of the thumb. 
  • The surgeon passes the free end of the FCR tendon through the hole and sews it back. 
  • The surgeon detaches the remaining portion of the FCR and preserves it as a spare tendon.
  • The surgeon removes all of the trapezium bone at the base of the thumb. 
  • The surgeon places the spare FCR tendon into the space created by removing the trapezium.
  • The surgeon keeps the spare tendon in the proper positioning with wires or pins. 
  • The surgeon smooths out the remaining surface of the CMC joint and closes the incision with absorbable or dissolvable sutures. 

What Happens After LRTI Surgery? 

After LRTI surgery, the orthopedic surgeon provides the following postoperative guidelines.

  • Wear a splint or thumb cast for six weeks
  • Keep hand elevated during the first month
  • Limit use of the surgical hand for a few days
  • Follow instructions on incision site care
  • Avoid or quit smoking, which affects bone healing 
  • Perform physical therapy to improve range-of-motion and strengthen muscles
  • Come to follow-up appointments to monitor progress

What Are the Risks and Complications of LRTI Surgery? 

As with any surgery, some of the potential risks and complications of LRTI surgery may include bleeding, infection, pain, swelling, shortening of the thumb, and damage to the bones or surrounding soft tissues.

Your thumb is too important to ignore. If thumb CMC is disrupting your quality of life, discover how LRTI surgery may be the solution for you.