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Artroplastia do polegar

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Updated Aug 2026
Uma ilustração desenhada à mão de uma mão fazendo uma pinça confortável entre o polegar e o dedo.
Raio X após artroplastia do polegar Touch: um implante de dupla mobilidade de pequeno porte recobre a articulação entre o trapézio e o metacarpiano do polegar — a articulação que se desgasta na artrose basal do polegar. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

Por que esta operação foi sugerida

Esta página reflete a forma como o Dr. Kieran Hirpara, cirurgião de membro superior no Mater Private Hospital Rockhampton, aborda este procedimento na nossa clínica. Sugerimos esta cirurgia quando a artrite por desgaste na base do seu polegar causa dor e rigidez que não melhoraram o suficiente com o tratamento não cirúrgico. Geralmente, tentamos primeiro alterações na atividade, terapia, talas ou injeções. Se estas não proporcionarem alívio suficiente, a cirurgia pode ser o próximo passo.

A artroplastia total restaura a articulação entre o osso do seu polegar e o osso do pulso. O objetivo é reduzir a dor, melhorar o movimento e restaurar a força. Para pacientes com artrite isolada nesta articulação, o implante Touch® apresenta uma taxa de sobrevivência de 96% aos 2 anos. Isso significa que o dispositivo permanece no lugar e funcional para a maioria das pessoas durante esse período. Encaramos isso como uma decisão compartilhada para ajudá-lo a recuperar a função diária.

Antes da cirurgia

Jejum por seis horas antes da sua cirurgia. Interrompa o uso de anticoagulantes apenas após receber instruções específicas do seu cirurgião. Organize um transporte para casa e traga uma lista de todos os medicamentos atuais. Você precisará de raios-X recentes para mapear sua articulação. Exames de sangue avaliam sua saúde geral. Uma avaliação anestésica garante que você está apto para o procedimento. Vista roupas largas e confortáveis ao vir à nossa clínica. Queremos que você se sinta preparado e tranquilo. Seu cirurgião irá guiá-lo em cada etapa. Esta simples preparação nos ajuda a focar no seu conforto e segurança durante o procedimento.

No dia da cirurgia

Você chegará ao hospital e será internado em seu quarto. Nossa equipe realizará as verificações finais. Você conhecerá seu anestesiologista para discutir seu conforto e segurança. Esta cirurgia é realizada sob anestesia geral. Você estará completamente adormecido durante o procedimento. Alguns pacientes podem receber também um bloqueio nervoso regional para alívio da dor pós-operatória — a decisão cabe ao anestesiologista no dia da cirurgia, com base nas suas condições individuais.

Em seguida, você será levado ao centro cirúrgico. Nosso cirurgião realiza este procedimento por via aberta, com uma única incisão convencional sobre o local da cirurgia. Isso permite acesso claro à articulação. Após o término da cirurgia, você despertará na nossa área de recuperação. Nossas enfermeiras monitorarão de perto sua evolução. Você permanecerá em repouso nesse local até estar estável e apto a ir para casa. Fornecemos instruções claras para o seu primeiro dia de recuperação.

O que a cirurgia envolve

O seu cirurgião faz um único corte sobre a base do seu polegar para aceder à articulação. Esta abordagem aberta permite uma visão clara da articulação trapezometacarpiana, também conhecida como articulação da base do polegar. O cirurgião remove as superfícies articulares desgastadas causadas pela osteoartrite, ou artrite por desgaste.

Um implante metálico e de plástico substitui a articulação danificada. O seu cirurgião prepara cuidadosamente o leito ósseo para acomodar os novos componentes. Isto envolve moldar a cavidade óssea e fixar a taça do implante no lugar. O posicionamento correto destas peças é crucial para um resultado fiável. O cirurgião assegura que o implante fique bem fixo para restaurar o alinhamento e o comprimento normais do polegar.

Uma vez que a nova articulação esteja no lugar, o seu cirurgião fecha o corte com pontos de sutura ou grampos. É aplicada uma cura para proteger a área. O procedimento foca-se na remoção dos esporões ósseos que causam dor e na restauração do movimento suave. Limitar cargas pesadas no polegar após a cirurgia ajuda a proteger a nova articulação e a apoiar a sua longevidade.

Após a cirurgia

Você acordará na sala de recuperação com a mão em uma atadura e um curativo protetor. Controlamos a dor utilizando métodos padrão para manter o seu conforto. A maioria dos pacientes permanece internada por uma noite após esta cirurgia, embora alguns possam ir para casa no mesmo dia. Você deve ter alguém para ficar com você nas primeiras 24 horas. Recomendamos limitar a carga no polegar para apoiar a cicatrização. Você usará uma tala de polegar tipo spica por quatro a seis semanas. Não dirija enquanto a tala estiver colocada, pois isso impede que você segure o volante com segurança. Você poderá dirigir após a remoção da tala e com a autorização do seu cirurgião. Consulte Dirigir após cirurgia do membro superior.

Recuperação

Terá uma única incisão na base do seu polegar. Nos primeiros dias, o inchaço e a rigidez são normais. O seu cirurgião irá orientá-lo sobre como gerir este desconforto. Mantemos o seu polegar protegido com uma tala para permitir a cicatrização dos tecidos. Este suporte ajuda a limitar a tensão sobre a nova articulação, o que contribui para a longevidade do seu procedimento.

Usará uma tala tipo polegar (thumb spica) durante quatro a seis semanas. Não conduza enquanto usar esta tala. Ela impede que agarre o volante de forma segura. Pode voltar a conduzir após a remoção da tala e com a autorização do seu cirurgião. Para mais detalhes, consulte Conduzir após cirurgia do membro superior.

À medida que o movimento regressa, iniciará exercícios suaves. A terapia da mão após a cirurgia é realizada com a Ruby Doolan na Extend Rehabilitation. O seu terapeuta irá ajudá-lo a recuperar a força e a destreza. Irá retomar gradualmente tarefas diárias leves, conforme a dor o permitir. O seu cronograma pode variar; o seu cirurgião e fisioterapeuta irão orientá-lo.

O que pode correr mal

A maioria dos pacientes tem uma boa evolução, mas ocasionalmente podem ocorrer problemas. O seu cirurgião e a equipa monitorizam-no de perto para detetar qualquer problema precocemente.

Por vezes, o implante pode não permanecer firmemente no lugar. Isto chama-se afrouxamento. Pode notar uma dor profunda no polegar que não melhora com analgésicos habituais. A dor pode parecer pior quando tenta fazer pinça ou agarrar objetos. Se isto acontecer, ligue para a nossa clínica para que possamos avaliar o seu polegar.

A peça de plástico dentro da prótese articular pode, por vezes, partir-se. Isto é conhecido como fratura do revestimento (liner). Pode sentir um clique, um ranger ou um estalo súbito no polegar. Pode haver novo inchaço ou dor que pareça surgir rapidamente. Como isto pode ser difícil de visualizar em radiografias padrão, precisamos de o examinar cuidadosamente. Por favor, referir este assunto na sua próxima consulta de seguimento ou ligue-nos mais cedo se a dor for grave.

Em casos raros, o osso onde o implante está assentado pode rachar. Isto é uma fratura do trapézio. Pode sentir dor aguda e observar inchaço logo após a cirurgia ou durante a recuperação inicial. Se sentir um estalo súbito ou dor intensa, pare de utilizar a mão e contacte a nossa equipa imediatamente.

Também queremos ser claros sobre o que deve evitar. Alguns tipos mais antigos de próteses articulares demonstraram taxas mais elevadas de necessidade de nova cirurgia. Não utilizamos esses designs específicos. O nosso foco recai sobre implantes que demonstraram estabilidade ao longo do tempo. Se estiver preocupado com a sensação a longo prazo do seu polegar, podemos discutir isso consigo.

A tabela de complicações nesta página lista as taxas típicas, caso queira os detalhes específicos.

Quando nos ligar

Ligue-nos se desenvolver febre, vermelhidão crescente na ferida ou secreção, ou dor intensa súbita. Vá à emergência se notar inchaço na panturrilha, falta de ar, perda de sensibilidade ou incapacidade de mover o polegar. Queremos identificar quaisquer problemas precocemente. Entre em contato imediatamente com nossa clínica se algum desses sintomas ocorrer, para que possamos avaliá-lo prontamente.


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