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CMC Arthroplasty with Artelon Spacer Expand / Collapse
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KeaC
Posted Sunday, November 12, 2006 10:03 AM


 

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Anyone out there who's had this fairly new surgery with the Artelon spacer? I'm having this surgery on Tuesday, and wondered if anyone else on the board has had this surgery, and has any bits of advice to share.


This surgery is starting to replace the one where the wrist bone (trapezium) is removed and a tendon replaces it. The Artelon (manufacturer's name) spacer made of some sort of woven fabric which is formed into a "T" shape. This is inserted between the thumb and wrist bones, then screwed into place. Both bones are sculpured a bit before insertion so that the spacer fits nicely. Recovery includes: a week of post-op bandaging, then 6-8 weeks of a cast, then 6-8 weeks with removeable splint, followed by 9-12 months of PT. One of the advantages of this procedure is that it leaves the option of having the trapezium removal surgery later, should the joint need attention years down the road.

Read a few of the related topics, and just want to thank everyone for their insightful advice. Great board!
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Penni in Virginia
Posted Wednesday, November 15, 2006 4:48 PM


 

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KeaC, I sure hope your recovery goes well! I know you're very happy to not have a lot of pain so far.. we've all been there, for sure!
I'm enjoying reading about your progress! Penni
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KeaC
Posted Friday, November 17, 2006 10:51 AM


 

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Thank you Penni.

It's now been 3 days since surgery and I'm doing really well. Going to see how it goes without any prescription pain meds today; yesterday I took less than half with minimal pain. In fact, there were times when there was no pain whatsoever...first time in 2 years - hooray!!

Four fingers all move well...in that "limited-movement manner" that the bandaging allows, and thumb can wiggle at the top joint just fine.

My pearl of wisdom to pass on to anyone having hand surgery and is told to keep it raised: Get one of those little neck pillows ahead of time. These are roundish, with a cut-out for your neck. Get one that does NOT have a plastic cover (too slippery), and IS filled with buckwheat, silicone granules or rice. Mine has a flannel cover. This thing has been WONDERFUL for helping prop up my hand and keeping it from sliding off the pillows at night or when I'm napping. It molds to your elbow or arm, providing great extra support when you're sitting next to a pile of pillows to keep the hand elevated. It goes everywhere I go this post-op week, and has really simplified the whole "keep it elevated" challenge.

I found my "neck pillow" at a Marshall's or Ross store for about $15.
Post #4098373
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KeaC
Posted Friday, November 17, 2006 10:59 AM


 

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Just updated an older post and now it's moved out of date order - sorry! This was from 11/15, the day after surgery:

I didn't hear back from anyone, but at some point others will want to know how this surgery went...

Had it done yesterday and 26 hours later, very little pain. Of course, I'm on Endoset and Ibuprofen, which are doing their jobs well. The trick is to take these with some food to avoid a stomach reaction. Frankly, I was in much more pain in the months prior surgery than I am right now.
Doctor said they found the CMC joint was bone-on-bone with no cartilege whatsoever left. No wonder it hurt so badly the past 2 years (motorcycle vs. car accident)!
Slept really well with pillows to keep the hand propped up.

Hand is in a temporary bandage for a week, then casting. Swelling has been minimal. I keep the hand raised above the heart 100% of the time.
Post #4098374
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KeaC
Posted Tuesday, November 21, 2006 8:42 PM


 

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It's been a full week since surgery, and I'm amazed at how well the first week has gone. Didn't need the Endoset after the 3rd day, except at night, and discontinued it entirely after the 6th night. One or two Ibuprofen in the morning to help keep swelling down, and an occassional Tylenol (for headache) is all that's needed now. I can use the middle, ring and pinkie fingers fairly well; the pointer finger is weak, but somewhat useful. Sleeping fairly well and have minimal pain overall...it's all going so much better than I had imagined - amazing.
Cast goes on tomorrow, and it's supposed to be much smaller and lighter than the bandaging.
Post #4098375
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Elizabeth12
Posted Wednesday, November 29, 2006 3:16 PM


 

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KeaC, thank you so much for your postings. I just saw a hand specialist yesterday about the Artelon Spacer surgery on my right thumb joint. I'm 39 years old and have used a brace and had two cortisone shots to no avail after initially injuring the thumb shoveling snow last January (no good deed goes unpunished, right?). The pain had become chronic, affecting my ability to play the violin, put on gloves, etc., and even getting dressed in the morning caused pain (though not horrible). As a musician, and because the affected hand is my dominant hand, I'm wary of surgical procedures, but I'm getting to the point where the pain is interfering with my life and the things I need to do and the things I love to do (play in a symphony, quartets, etc.) I need to find some relief, and it seems that surgery is the "only" option at this point unless I give up music and learn to use my left hand more. I was so glad to see your postings, and I'm so glad you are doing well! I will keep checking this site to look for any updates you might post as you continue in the recovery process. I'm about to schedule surgery for late December or early January. Thank you!
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Piano Rick
Posted Tuesday, December 05, 2006 11:01 PM


 

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Hello--another musician here. KeaC, you're leading the way for all of us, I guess. Thanx for your postings--keep 'em coming. Artelon just came out with the male-size spacer a couple of months ago. I'm a pianist, so my Loma Linda hand specialist recommends Artelon spacer over the tendon arthroplasty--mobility is a major issue. I'm looking at January procedure, then if happy, the other hand as soon as possible. My MD is not talking about a lot of PT after 6 weeks in a splint. Maybe he's painting an overly optimistic picture because he wants to practice on me. What did your doc say about PT? Anyway, though I recently broke down and joined AARP, 56 is still way too young to retire from music.
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mommabird62
Posted Friday, December 08, 2006 8:45 AM


 

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Hi! I, too would love to hear some input on this procedure. I am having it done bilateral (with screws), one at a time of course. I have suffered with RA and osteo for many years, along with years of steroids, splints, rx's,etc., and due to my young age, replacements have been put off. I'm 44 and was referred to a hand specialist who has a wonderful reputation.

Though the curious side of me wants to know more about the surgery, therapy, ect., ahead of time;-)

I am really looking forward to having this done as it's my final option. I will be staying at least 24hrs at the surg center. I am very petite and have notoriously low blood counts, etc. That's my only concern. As far as post-op pain and rehab I'm up for all it takes! Hey, I'm used to it. The next replacement project will be my knees once they have done all of the steroid injections there that they can.

So, I am all ears for the input!

My first one will be on 12/26 and hopefully the other one 2-3 months later.
Thanks, mommabird
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sharon1
Posted Friday, December 08, 2006 9:45 AM


 

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Hi! I'm new here but I'd like to share. I had my surgery on Oct.31,06 and they put my hand in a splint with a drain. I had to go back the next day to have that removed and they put me in a hard cast. I went back on Nov.15 and they removed that cast and my stitches and they put another hard cast on Docter told me that I had to wear this one four weeks. I go Dec.13 to get the cast off and get x-rays that's as far as I've gotten. My docter doesn't tell me very much, but I didn't know what to ask. I've been trying to find out more and I did find a movie clip of this surgery if anyone would like to see it go to www.totalsmallbone.com that the company that sells the spacer.Thanks for your time and let me know what you think.I'm 45 and I've been a dog groomer for 24 years.
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Elizabeth12
Posted Tuesday, December 12, 2006 9:17 PM


 

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I'm so glad others are posting! I've scheduled the surgery for January 3, and I'll let everyone know how it goes. I'm nervous as anything, but I'm crossing my fingers and praying that all goes well and I can regain the pain-free use of my right hand. Happy holidays to all!
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Piano Rick
Posted Wednesday, December 13, 2006 7:44 PM


 

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Who can comment about post-operative post-cast physical therapy?
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Elizabeth12
Posted Thursday, December 14, 2006 5:32 PM


 

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Piano Rick, don't know if this helps, but my doctor has told me to expect 5 to 8 PT sessions if all goes as expected. The first two weeks will be twice a week, then the rest more spread out. Don't know what it will entail, but I do understand that I'll have to do much of the work on my own for several weeks or even months, depending on how things progress.
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sharon1
Posted Thursday, December 14, 2006 6:16 PM


 

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Hi! I just got the cast off yesterday and just had my first PT. My docter has me down for 3x aweek for the first 4 weeks then back to see him. My PT tells me 12 weeks total but that it takes time.
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Piano Rick
Posted Friday, December 15, 2006 12:46 AM


 

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Well those stories are a little different. Thanx for the response. I'm set for January 19 right hand surgery. Whatever happened to KeaC? She started this strand. KeaC!!!!!
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KeaC
Posted Saturday, December 16, 2006 11:14 AM


 

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Sorry for the delay...caught up in the holiday rush these days. Glad to see there are others out there going with this same procedure.
First, a quick progress update : It's been 4.5 weeks since surgery and things are going quite well. Minimal pain - still - and no need for any pain meds whatsoever, prescription or over-the-counter. The cast comes off in 4 days (can't wait!) and I'm more than ready to give the skin underneath it a good "scratch". The thumb is able to move around (within the cast, of course) without pain, and can do "lightweight" things such as holding a pen. Typing is no problem; writing gets uncomfortable after a couple words. Still can't hold a glass of water or a plate of food...no grasping of things just yet. PT starts the same day the cast comes off, which will be replaced with a removable split.
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KeaC
Posted Saturday, December 16, 2006 11:37 AM


 

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On to the questions asked...

ELIZABETH 12 - I'm glad that you're going to proactively get treatment so that you can return to your music! If you feel up to it, let us know how you're doing after surgery.

PIANO RICK - Didn't know that a different size was needed for men, but it makes sense. Regarding PT...I was originally told that PT would be 9-12 months, but that was with the original approach (removal of trapezius bone and replace with forearm tendon). I'm not sure what to expect now, and will be sure to ask my hand doc on Wednesday. Originally, the cast was to remain on for 6-8 weeks, but it's coming off after 4 weeks, so the Artelon spacer approach seems to require much less recovery time...good news for us! By the way, I'm 51, just to give you an idea of age vs. healing time.

MOMMABIRD62 - I can truthfully tell you that the post-surgery recovery has been SO MUCH EASIER than I anticipated. Everyone is different of course, however it's always good to hear from people about their experiences. The hardest part was the first week, with the pressure bandage, which was huge. You truly have only one hand to use that first week. Once the cast goes on, you have at least the last 3 fingers at your disposal, which helps greatly, then in another week or so, your thumb and forefinger start being a little useful. Plan on preparing your house, food, meds, bathroom, etc., in ADVANCE for having just one hand to use. Example: zip-lock bags are difficult to open and close, so use plastic wrap instead. Cooking is pretty much out of the question, so have pre-prepared foods ready to go. (this is all based upon my situation; I'm right-handed and had surgery on the right hand, so lots of left-handed clumbsiness came into play)

SHARON1 - Your procedure sounds the same, but our post-op procedures were very different. I'm wondering, did you have any swelling problems? Also, what did they have you do in your PT sessions? (we're all interested!)
Post #4098386
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KeaC
Posted Saturday, December 16, 2006 3:47 PM


 

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...and one last post for the day, under the topic: what happens when your pressure bandage is removed (and cast is applied).

My pressure bandage was pretty large and took a few minutes to unwrap with the various layers of Ace bandage, cotton batting, etc. The incision was about 2.5 inches long, and held together by 4 steri-strips. I was surprised to see no "stitches" whatsoever, no blood, no clots or leakage of anything. There were two ends of a thread, each about 2 inches long, and yes, the nurse grabbed one end and pulled it out quickly. That stung quite a bit (worst pain I've felt so far in the healing process), but was fine in a couple minutes. The doc checked out the incision, felt around to be sure there was no nerve damage in the surrounding skin area, and pronounced that "everything looks good". The steri-strips were left on the incision and will be removed when the cast comes off.
These new fiberglass casts are great! It went on in about 3 minutes and is much smaller and lighter than the pressure bandage. It took about 5 minutes to dry totally. They've come a long way since the plaster-of-paris casts of my childhood!
Definitely looking forward to getting the cast off this coming week, and starting PT.
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sharon1
Posted Saturday, December 16, 2006 7:06 PM


 

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Hi! I wouldn't mind at all sharing my first PT session . I'd also like to add that I could hardly wait to srub my hand when the cast came off. The first thing my PT said to me was that I was to young for this which I already knew. She had me do some range of motion moves then 20 min. moist heat raps then thumb rotations, thumb moves away from index finger, away from my palm touching the tips of my index and middle fingers and making a fist. Then massage with lotion and then she put a lite rapping on to help with swelling that's what she has me doing at home til I see her on Monday. My docter doesn't have me wearing a splint my PT says every docter is differnt. He has me down for PT 3x aweek for 4 weeks then I'll see him again. My PT thinks that I'll have at least 12 weeks of PT all together. She couldn't say for sure when I might return to work because my right hand is my dominent hand that I groom and scissor with. It all takes time she says. Thanks for letting me share.
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mommabird62
Posted Sunday, December 17, 2006 4:24 PM


 

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Hi! Thanks guys for all of your input. I know a little more about what to expect now. Doesn't sound too bad. I'm getting the left one done on the 26th and the right one @ two months later.

Then, the next job will be my knees. I'm going to try the Synvisc injections first and see how long that will get me. I think I've my limit on steroids! LOL My job requires me to be on my feet all day (10-14hr days)so I'm willing to try anything. My doctors agree that I am a bit young (44yrs)but these are my last options and it's been going on about 10yrs.

Good luck y'all and I'll keep checking back in;-)

mommabird
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NanaSusan
Posted Monday, December 18, 2006 12:40 AM


 

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Just found this discussion board and so glad I did. Two weeks ago I was told I needed surgery of the base of the thumb. The doctor explained how the operation was performed. I went home and googled it and learned about the Artelon Spacer. I printed the page out and left it at his office so on Tuesday when he comes in I can get his feedback. I called the hotline for Small Bone Innovations and received a phone call back and an e-mail with doctors in my area that use the Artelon method. I live in New York. Can anyone recommed a doctor that you have used for this? Not sure what I am going to do since I am a hairdresser and will not be able to work for quite a while. (no work equals no pay for me) I also found a professor in Toronto that makes splints that are lightweight, flexible and breathable. I plan on going to Toronto in January to have it made. Any information you can pass my way is very appreciated!
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