For full transparency this video has been posted by the surgeon so I, as the surgeon, am replying. With a total joint replacement the geometry is maintained (the thumb is not shorter after surgery) so this maintains better function when compared with other surgical options. Where in the world are you messaging from?

@@asjepson Jacksonville Fl USA

Yes - very different. In the Ligament Reconstruction the trapezium is removed and the tendon interposition is used to maintain the height of the thumb whether it was. In a CMC joint replacement the trapezium is preserved and a joint replacement introduced. This preserves the length of the thumb which provides more consistent results in terms of strength and function, as well as a faster recovery.

@@mralistairjepson-orthopaed7809 1. Is the joint replacement taken from the patient's body or external source? 2. How would you compare it to the BioPro Modular Thumb Implant?

The joint is not from the body - it’s made in an implant factory. The difference with BioPro is that implant I use (the Maia) is this a total joint replacement with a ball AND a socket as opposed to just half a replacement.

@@asjepson Is the Stablyx CMC Arthroplasty System by Skeletal Dynamics also just half a replacement? What are the benefits of total joint replacement compared with half?

Yes it’s also only half a replacement - a different shaped one though (it’s a saddle shaped surface to match the trapezium whereas the BioPro is ball shaped. A total joint replacement means a better outcome in terms of pain relief as there are no arthritic surfaces left in place.

Thanks for your comment. This video has been posted by me (the surgeon) with the patient’s consent so I can’t comment directly but last I spoke to the patient he remained very happy. The operation he had was a total thumb joint replacement, not cutting out the bone and putting in tendon, which is an operation called a trapeziecotmy and tendon interposition. This is an operation I now rarely do as I have found the results of the thumb joint replacement better and more reliable.

Certainly the available surgical options over the years have improved. We did not have a reliable thumb joint replacement 15 years ago when you had your right thumb surgery so what you had done was no doubt the right option at the time. Once a trapeziectomy starts to gove problems though it’s very difficult to reverse the situation. A replacement for your left thumb would indeed be a better option. A total joint replacement isn’t yet available in the USA (needs FDA approval) so I’ve had a few enquiries from patients in the USA and indeed had one patient come over for surgery, and he’s comfortable back for his other side soon. A hemi / half replacement is currently the only option in the USA.

Maybe I can jump the pond and have you do the surgery. What would be the cost if I pay out if pocket?

The hope is the replacement should last as long as a hip replacement i.e. 10+ years (hopefully up to 20) but the implants haven’t been around long enough to have long term results yet.

Thank you for getting back to me. This info really helps. Take care 😉

I’m very sorry to hear that. There are a number of different types of joint replacements available and without the full details I don’t know what you had done. I don’t believe you have been under my care.

Extremely unlikely for this to happen. Sorry for the late reply.

​@@mralistairjepson-orthopaed7809Hi there. I had this type of surgery done 2 weeks ago, spending only one week with the bicep totally torned. About how much time should I spend off gymnastics? My doctor suggested 9 months off....

Yes absolutely

@mralistairjepson-orthopaed7809 I've heard horror stories of things being much worse than before surgery,what would your advice be?

@@glenscott3083 that’s absolutely not been my experience. In fact patients with a basal thumb joint replacement are some of my happiest patients. Like any operation it has to be the right operation at the right time in the right patient.

Not right away!

My surgeon wants to remove the trapezoid and create a sling in that space. I found out my friend had a carbon implant from the same surgeon and she is doing great. The surgeon didn't even present the carbon implant as a possibility for me. My friend is female and we are the exact same age. Can you think of a reason why he wouldn't even have mentioned the implant as an option?

Good luck

Did you have it done in the U.S.?, do you mind sharing where as I am thinking on the same. Thx.

There are two different types replacements on the market - a hemiarthroplasty (replacing just one side of the joint) and a total joint replacement (both sides replaced); I perform a total joint replacement (Maia) which is different to the BioPro (a hemi). The Maia is not available in the USA yet however (getting FDA approval is complex). It’s a French implant and it now has 10 year data published with extremely good results. It’s true the published results are shorter than for a trapezectomy and interposition (anchovy) but that’s because it’s a newer operation. I can’t comment personally on the BioPro but I do know I’ve almost stopped doing trapezectomy because of the excellent results of the dual mobility Maia implant. After an open discussion about the pros and cons of all the options most patients prefer the outcome of a stronger thumb, better arc of motion, and quicker recovery in order to maintain their work& hobbies. They accept they might need a revision operation in the years to come…and a revision to a new Maia to a trapezectomy are both still possible, if that situation arises. Long reply, sorry, but hope that helps.

Thank you so much for your reply. I wish they had this in the United States. I may just go with the BioPro, pain is getting bad and shots don't work any more.

I can confirm the strength is excellent following this surgery and it’s definitely a lot better than after a trapeziectomy. I have done around 70 replacements so I hope that reassures you.

@@mralistairjepson-orthopaed7809 Thanks for response. Very quick. Sounds reassuring. I'll make contact separately.

@mralistairjepson-orthopaed7809 Hello Mr Jepson. I am waiting for CMC Trapeziectomy and Carpel Tunnel surgery at the same time. I am confused as to the best procedures, there seems to be so many. I saw a KZbin video where a guitarist had a joint replacement carried out by yourself and was impressed at the recovery time. I too am a guitarist and would like to enquire into the possibility of you carrying out this procedure and the cost. You have carried out 70+ of these operations. What is the success rate? What is the waiting time? Many Regards, Dennis Webster

@@FireiskLtd Hi Dennis. Very nice of you to make contact. Yes the options are somewhat confusing but since starting to do joint replacements in 2018 I have not looked back, to the extent that I almost never do what regarded as the best option previously - a trapeziectomy (either with and without a ligament reconstruction). I have found the replacement to be one of the gratifying operations I do for patients too. And in that time I have to do not had to revise any of the replacements I have done (touch wood and fingers crossed!). More and more of my colleagues are learning of the great clinical results too and switching but obviously not all yet. You look young and obviously your guitar playing would also lead me to recommend a replacement. The cost is similar to that of a total hip replacement, around £10-11k. I am based primarily in Northamptonshire. Please feel free to email: [email protected] for confirmation of pricing.

Correct. It’s personal preference. In fact I rarely use a screw myself. I just make as small a hole as possible so the tendon is tight in the hole and no screw is required.

Hi Jerry. Thank you for your interest in this procedure. I am the surgeon who performed this operation (and upwards of 60 other replacements in total now). I am pleased the video has proved so useful to you and so many other guitarists, of whom a few have come to see me to discuss treatments, and whilst not all have required a thumb joint replacement a number have, and I am pleased to say they have all done well. The guitarist in this video is a professional musician @solsticeuk and he is now 2 years post surgery (his own comments are listed in the reply to @paulgriffiths3613 below). I'd be very happy to undertake a consultation with yourself if you wished. Are you based in the UK or abroad?

@@mralistairjepson-orthopaed7809 I’m in the United States

Hi Paul, I’m ‘that man’. To be perfectly honest, 2 years + on, I only ever think of my thumb replacement when recounting the story. I have absolutely no issues with pain, numbness, restriction of movement or, perhaps most importantly, the inability to play for sustained periods. I teach 3 days a week and perform 90 minute sets frequently. My band (this channel) played extensively through 22 and we have a rapidly filling diary for 23. Talk about a new lease of life! Im not blowing smoke here but I will literally be forever grateful to my surgeon… and if I have a problem with my right hand (for which X-rays suggested the same joint degeneration but perhaps because I don’t require the same grip strength has not yet caused me a problem) I’ll know where to go. This is an album promo but shows me on stage last year in Italy. There are many more recent videos in our channel which I’m sure provide plentiful evidence of my continued facility. Very best, Andy kzbin.info/www/bejne/bnzKfoKurdSJqKc

@@solsticeuk Thanks very much for that.I know that there are less expensive options,but your experience tells me that this is the way to go.Thanks again.

@@paulgriffiths3613 Good luck!!

@@solsticeuk Hello there Thank you for posting this informative video. I am so impressed with your speedy recovery from this surgery (as well as your skilful playing!). Whilst not the same joint as yours, I wonder if you know any right handed guitar players who have had their middle finger left hand fused? This is therefore my fretting hand. My middle finger is badly bent from a fracture years ago, later developing arthritis, which now crosses over my ring finger when playing. My intended surgeon seems to think that I’ll still be fine to play guitar, but I can’t imagine making clean shapes on the fret board, with my middle finger unable to bend at the dip joint? I asked about a joint replacement instead, but was told the dip joint is too small. I wonder if you have met other players with a fused middle finger on their fretting hand? I’m currently booked in for surgery on 23 November, but getting cold feet! Kindest regards to you.

@@paulgriffiths3613 What is the cost from what you have found out in your research?

only if your tendons get irritated by it. Otherwise not worth it.

Please bear in mind this is the guitarist’s surgeon speaking. I have been doing this operation since 2018 and the results speak for themselves and the results are maintained to date. I have had no complications and not required to redo any. Many patients have come back to have their other side done too. I am very much continuing to do this operation although one always has to be a careful to not jinx things.

@@asjepson "Jinx things".. I hear that. Where are you located? thnx

@@asjepson London UK..

@@RSTI191 My main practice is at The Three Shires Hospital in Northamptonshire (an hour north of London) and I do sometimes consult in London (by prior arrangement) at the Harley Street Specialist Hospital

@@asjepson Thank you for the response. I'm in California. Are you familiar with this procedure? kzbin.info/www/bejne/iaachIebps2if6s If so, do you recommend it? Thank you again for your time Signed, Once Very Concerned Individual..

It was a base of thumb CMC joint replacement using a Maia implant. I don’t believe this operation is currently available in the USA but it is available in UK and Europe.

@@asjepson thanks for that info. Hope it's working well for you.

@@mikemyles4916 I’m the surgeon who did the operation. The video was posted with the patient’s consent.

@@asjepson got it! 🙂

I’ve replied to your email Graham directly

don’t have fusion if you want to play guitar or piano

It was a full joint replacement; nothing specifically tendon related

I promise you it’s exactly as you see it - no magic tricks involved. A motivated patient combined with a great implant. It is a lot slower rehabilitation for index, middle, ring and little fingers surgery though.

At the moment this implant is not available in the USA though and, for that reason, I have in fact had a patient come over to see me for surgery.

This surgery has been in the US for quite some time. But not in all States.

@@worthmor5146 What states it is available at?

@@worthmor5146 Are you sure it is the MAIA or other implants?

Hi William. I’m delighted by how much interest my post has created. The survey essentially involved insertion of a microscopic hip replacement (ball and socket joint). The materials used as metal and plastic. There are obviously stitches to close the wound but the implant does not involve a stitch or a tendon - that sounds more like the ‘traditional’ operation of a trapezectomy with tendon stitched into the gap. I hope that helps.

How are you doing now? I had my fretting thumb done in Oct 23 but a very highly rated surgeon who plays guitar. Its now been almost 5 months and although I can play lead pretty good it is still quite painful to squeeze bar chords. Im a bit disappointed but still have hopes that it will completely health so I can play without pain. I had my right thumb done 14 months ago. It took me almost a year to hold the pick while strumming hard. Maybe my surgery was a little different? He cut a bone out and used a tendon to make a new cushion in the joint. Is that what you had?

The replacement was for osteoarthritis of the base for thumb (the CMC joint), which sounds like a similar problem to your own. Surgery is never the first option but if things are bad then it might be something to consider in the fullness of time…and this operation would likely be my recommendation. If I can be of further assistance please don’t hesitate to email me: [email protected]. Alistair Jepson.

Hi Tim. Really sorry but I don’t use Facebook. I will message the patient though privately, on your behalf, to see if he can reply. I’m pleased to report he continues to do very well, and has now been discharged in fact.

@@mralistairjepson-orthopaed7809 Very much appreciated, thank you.