Maybe you’ve noticed it slowly. Jars won’t open. Buttons take two tries. There’s a deep, toothache-like ache right at the base of your thumb, and you’re starting to wonder if something is seriously wrong with your hand.

That joint is called the basal joint, or the thumb CMC joint, and arthritis there is the most common arthritis hand surgeons actually treat. I don’t operate on hands. I do hip and knee replacements, so I went looking for an operation that could rival a total hip, and it led me to this one. To get honest answers I sat down with Dr. Brian Hardy, my partner at Texas Orthopedics, a fellowship-trained hand surgeon and a good friend.

We walk the whole path. What the basal joint is and why it wears out. What the pain feels like and where it shows up. The non-operative options that keep many patients out of the operating room for years, and sometimes for life: braces, anti-inflammatories, topicals, hand therapy, and simple tools that take the load off your thumb. Then, if none of that is enough, when surgery finally makes sense.

Dr. Hardy also names the operations you may hear about: trapeziectomy, LRTI, suspensionplasty, and suture-button. If you’re trying to figure out which one is best, his answer is the honest one. The best operation is usually the one your surgeon does best. And then the part you probably care about most: about four weeks in a cast, a nerve block that covers roughly the first three days, hand therapy starting around week four, and a recovery that keeps improving for a full year.

This is a surgery I don’t perform. It’s also one I may need myself someday, because operating takes a toll on your hands. If your thumb is the reason you’re avoiding things you used to do without thinking, watch this before you decide anything.

This is education, not medical advice. Always follow your own surgeon’s and care team’s instructions.