Jan Zakary's CMC joint replacement surgery
Jan Zakary is a 54-year-old woman originally from Buckinghamshire. For years, she suffered mentally, physically and emotionally from debilitating joint pain in her hands, induced by arthritis. In 2019, Jan underwent a thumb joint replacement procedure at The Saxon Clinic, Milton Keynes. The following year, she had the same procedure on her other hand. Both of these surgeries were successfully performed by Consultant Hand and Wrist Surgeon Mr Andy Hacker
Jan's choice to have CMC thumb joint replacement surgery
Joint replacement surgery involves removing and replacing a damaged joint with an artificial one. Prosthetic joints come in different material forms, including titanium and silicon. After joint replacement surgery, most people will experience reduced pain and improved function in their affected joint.
Before surgery Jan had received regular steroid injections to manage her joint pain but with little success. Jan explains: "The arthritis in my hands was becoming worse. Steroid injections had made no difference. I wasn't even aware that replacement or implant surgery existed, at this stage."
36.84% of our survey respondents have had steroid injections to manage their joint pain. About half (47.43%) of respondents with pain in their hands and wrists have had steroid injections.
Consultant Hand and Wrist Surgeon Mr Andy Hacker explains: "There are a wide of range of treatments available for patients presenting with osteoarthritis at the thumb base. In my practice we start off with non-invasive techniques such as steroid injection, splinting under the care of a hand therapist, and alteration of their everyday activities. Whilst this may help with the pain initially, these treatments can become less effective and others options can be explored."
I felt like an elderly woman, old before my time... my mood was at rock bottom.
What is CMC thumb joint replacement surgery?
Jan's GP referred Jan to Mr Andy Hacker, at The Saxon Clinic, for consideration of a thumb joint replacement. Her first successful replacement significantly reduced the pain in one hand, however, in the months after surgery, whilst her initial thumb replacement healed, Jan had to rely on using her other hand. This exacerbated the arthritis and Jan's other hand became almost unbearable to manage.
"I felt like an elderly woman, old before my time," explains Jan. "I couldn't go to my gym sessions so my fitness was affected and I wasn't even able to hold my husband's hand if we were out walking or shopping. I absolutely love dogs but couldn't think to get one because I couldn't walk or care for it. The pain affected everything and my mood was at rock bottom."
Jan planned to have her second surgery the following year (2020). Mr Hacker performed the surgery in December and Jan instantly felt an improvement to her pain and overall mood. CMC thumb joint replacement surgery uses a mini ball and socket joint prosthetic, a scaled down version of a hip replacement, which aims to promote good pain relief, a more rapid recovery and improvement in hand function.
"In the last couple of years the design of thumb joint replacement has improved hugely," notes Mr Hacker. "A thumb joint replacement surgery offers several advantages over the well-established trapeziectomy procedure. A CMC thumb joint replacement surgery can give patients a better grip strength and an improved range of improvement. In my experience of this procedure over the past three years , their return to work and recovery time is significantly quicker than a trapeziectomy."
What happens during CMC joint replacement surgery?
CMC joint replacement surgery involves making a small incision (3cm) over the base of your thumb and removing the arthritic surfaces of the bone. The thumb joint replacement stem is placed into the metacarpal bone of the thumb. A small hole is made in the remaining trapezium bone, and a cup is inserted into this hole. The ball of the implant sits within this cup.
The components of the thumb joint replacement are coated with a substance called hydroxyapatite. This encourages bone to grow onto the implant and with time allows it to become 'part of you'. The procedure usually takes about 45 to 55 minutes and is carried out under a general anaesthetic or regional block. The operation is carried out on a day case basis.
Post-surgery, you will be given local anaesthetic and a well-padded bandage or plaster that will allow your wound to heal. After 10 to 12 days, you'll will receive a post-surgery consultation with a hand therapist and your surgeon to review your surgery and remove your bandages. You may be provided with a hand splint to support your hand.
Mr Hacker explains: "After a CMC thumb joint replacement surgery, we would hope that the patients range of movement and pain would be greatly improved. Sometimes, the range of movement does not improve, but the patient's perception of what they're able to do with their thumb is much better as they have less pain. In the vast majority of my patients who have had this procedure I have seen a huge improvement in their range of movement and pain scores."
There has been no downside to my surgeries. My mental health is completely different.
Jan’s recovery from CMC thumb joint replacement surgery
Although Jan underwent her second CMC thumb joint replacement during the COVID-19 lockdown (a challenging and uncertain time in general) she regards both surgeries as a positive experience.
"There has been no downside to my surgeries. My mental health is completely different. A month after my surgery, my husband and I moved up to Yorkshire and into our forever home. We have enjoyed many walks and being able to hold hands. I have also enjoyed decorating and arranging our new home, which I wouldn't have been able to do before."
Around 50% of people aged 35 to 64 with arthritis in the UK reported that they had missed special occasions with friends and loved ones as a result of arthritis. The data from our Joint Pain Matters campaign revealed 81.42% of respondents with hand and wrist pain said joint pain affected family life. In 2018, 18% of older people aged 65+ in the UK reported that arthritis had made them distant from their loved ones.
Meet Mr Andy Hacker
Mr Andy Hacker is a consultant hand and wrist surgeon at Milton Keynes University Hospital and The Saxon Clinic in Milton Keynes. After qualifying from the University of Newcastle upon Tyne, Mr Andy Hacker went on to successfully complete his post-graduate surgical training in London. During the specialist training that he received, he developed an interest in hand and wrist surgery.
Mr Andy Hacker accumulated significant surgical experience through working at a number of hospitals in and around South West London, working alongside orthopaedic and plastic hand surgeons.
A hand and microsurgery fellowship at the Royal Northshore Hospital in Sydney allowed Mr Hacker to work under the supervision of a globally renowned hand surgeon, Professor Michael Tonkin.
In 2010, he was awarded his Fellowship of the Royal College of Surgeons qualification. The following year, he joined the Milton Keynes Hospital Foundation Trust, establishing a dedicated hand and wrist surgery service.
Joint Pain Matters
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