By Alan Cassels
(the following article is condensed from an interview with Jarkko Jokihaara on March 16, 2026)
A common characteristic among the people at FICEBO is a self-awareness of their unique culture, which is marked by a sense of continuous quality improvement. It’s a yearning for knowledge, and a willingness to put in the effort to achieve it. Dr. Jarkko Jokihaara and I spoke by zoom and I started out by asking him how things were going.
“It’s the same as always, but better. We’re starting new trials all the time and every time we try to do things better,” he said.
Simple. Unpretentious. And powerful. And in those words, is captured the essence of Jarkko, a Professor of Hand Surgery at Tampere University Hospital and Tampere University and the Co-chair, FICEBO-Hand.
As the lead researcher on FICEBO’s 4th placebo-surgery controlled trial, the FINTASY trial, his team is examining the use of trapeziectomy, an operation considered the gold standard surgery for patients with painful thumb basal joint (CMC1 joint) osteoarthritis. The study will be conducted in the Hand surgery units in four different centres in Finland.
Jarkko explained: “It’s almost as common as knee problems but there is no good prosthesis for thumbs.” He explained that given the nature of this type of arthritis, “it’s very difficult to make small mechanically-durable prostheses. There is no perfect option.”
What is most interesting about the trapeziectomy—is how old it is. “It’s been around for at least 70 years,” Jarkko said, and while it involves removing the trapezium bone in the wrist to relieve pain, the published evidence behind it is almost non-existent.
“It’s funny, but no one has studied it well,” said Jarkko, chuckling as he recalls the details of the original paper. “It was a ‘study’ on two patients, in a half page article. He sent me the study he was referring to (from 1949) and it was about as succinct as one could find in the orthopaedic literature. “Case II.-Cowman, aged 48. Complained of pain in base of right thumb and was unable to work. X-ray showed osteo-arthritis of trapezio-metacarpal joint. Operation September 1946, excision of right trapezium. Was able to start milking within a month of operation and is now milking 20 cows a day”. [i]
It makes me smile to think that Jarkko’s important hand surgery is getting people back to milking cows quickly!
Jarkko says that the lack of published evidence makes the trapeziectomy the perfect study for a placebo-controlled trial in a condition which is much more common than we might think. Possibly up to 20% of people over 60 might have some symptomatic osteoarthritis in that part of the thumb.
I wondered about a hypothesis and he was forthright to say, “No, I don’t have a hypothesis. I don’t like them. I know that they always expect us to have a hypothesis. But I don’t want to guess. I try to be neutral,” he said, adding “we’re always working towards better knowledge.”
New knowledge is vitally important in his field, and it’s particularly hard to find because of the scarcity of specialists in this area. Because there’s only a small number of surgeons who specialize in hand surgery in Finland, (only a handful?) he’s constantly collaborating with others in Nordic countries, England and Germany. “It’s a great group of people who have unique skill sets, which is very rare. I’m proud to be part of that.”
He admits that his patients are unique.
“My clinical work—to put it bluntly—is to treat patients with conditions which no one really knows..." Usually these are patients with nerve conditions or congenital conditions. We get referrals from all around the country. We can’t do RCTs on these kinds of patients because there isn’t enough of them.”
He does, however, approach his clinical work with the curious mind of a researcher. “We have a protocol with patients. We decide the best option for a particular condition, but then we set up a study, then we test it.”
He feels that he is continually learning: “with each new patient, hopefully we can learn something along the way — It’s a practical protocol as well as a study protocol. This approach immediately benefits the patient in question — and the future patients, too."
Towards the end of our conversation, I knew Jarkko had some admiration for a famous Canadian we both knew, the famed Dr. David Sackett, who worked at McMaster University in Hamilton and who is considered by some to be the father of evidence-based medicine. Over a decadeago I spent a whole day interviewing David Sackett at his house at Irish Lake, when I was writing a book about the Cochrane Collaboration, which he helped co-found. I left deeply impressed with his candour, his principled insistence on evidence, as well his humility toadmit his ignorance.
Jarkko said: “Sackett is a phenomenal example, of being a clear communicator. He writes with a vast knowledge on very difficult topics and when he explains something he uses simple language.”
In a way, Jarkko, is channelling the spirit of David Sackett, when admitting that “we often don’t know what we’re doing.” That honest admission is the sentiment that infects a lot of work of FICEBO researchers. The idea that if you don’t know something, the best thing you can do is carry out an honest trial.
Jarkko’s final word sums it up best: “One has to be honest about not knowing something.”
[i] Gervis W.H. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg Br. 1949;31(4):537–539.
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