Royal Derby Hospital researchers leading ground-breaking trial into thumb base arthritis treatment
Researchers from the Pulvertaft Hand Centre at Royal Derby Hospital are leading the way in a pioneering national study to determine the most effective treatment for thumb base arthritis, a condition that affects millions of people across the UK.
Base of thumb osteoarthritis (BTOA) is a common and painful condition, affecting one in five people over the age of 40. The condition can make simple everyday tasks such as opening jars, turning keys, or even writing, extremely difficult. This can heavily impact the person's independence, work, and overall quality of life.
As part of the SCOOTT trial (which stands for Surgery versus Conservative OsteOarthritis of Thumb Trial), a multi-centre study funded by the National Institute for Health and Care Research (NIHR) with a grant of over £2 million, the Pulvertaft Hand Centre at Royal Derby Hospital is working alongside South Tees Academic Centre for Surgery, the University of York, and the University of Nottingham to assess three different treatment options for BTOA:
- Non-surgical management (ENGAGE) package – a structured programme that does not require an operation, which includes exercises, splints, task modification, pain coping strategies, and potentially steroid injections.
- Trapeziectomy surgery – the standard surgical treatment, which involves removing the small arthritic bone at the base of the thumb to relieve pain.
- Carpometacarpal joint replacement (CMCJR) – a newer surgical technique, replacing the damaged joint with an artificial one (similar to how a hip replacement is performed).
Currently, there is no definitive evidence on which treatment is most effective, and the trial aims to provide much-needed answers by comparing surgical and non-surgical approaches, as well as assessing whether joint replacement surgery is as effective as the long-established trapeziectomy procedure.
UHDB is playing a key role in the study and has already recruited the highest number of participants so far - enrolling eight out of the ten patients currently taking part, despite the trial only recruiting patients in late 2024. The trial is expected to expand further as more organisations and their sites take part.
The Pulvertaft Hand Centre, based at our Royal Derby Hospital site, is one of the UK’s largest and longest-established specialist hand surgery units. It is home to a team of expert orthopaedic and plastic surgeons who treat a wide range of complex hand conditions. The centre is recognised internationally for its research and is a major training hub for future hand surgeons.
Mr Nick Johnson, consultant hand and wrist surgeon at UHDB and Co-Chief Investigator of the trial, said:
“This is the largest study to date comparing these three treatment options, and its findings will provide strong evidence on the best way to treat this common, and debilitating condition.
"Our goal is to improve patient outcomes while also ensuring the NHS more widely can offer the most effective treatment.”
Ms Emma Reay, consultant hand and wrist surgeon at South Tees and Co-Chief Investigator of the trial, added: “This is the first study of its kind, and we are delighted to be answering such an important, and timely question in hand surgery"
Patients can also contact the Pulvertaft Hand Centre directly through their website > or speak to their GP about being referred to a participating site.