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Thumb CMC arthroplasty

Surgeon-side topic for thumb cmc arthroplasty. Backed by 427 articles from the corpus, retrieved via combined MeSH + title-text matching.

135 citationsUpdated Oct 2026

Overview

Thumb carpometacarpal (CMC) joint arthroplasty addresses osteoarthritis through several surgical strategies, including total joint replacement, suture suspension arthroplasty (SSA), and trapezio-metacarpal arthroplasty. Total joint arthroplasty is efficacious, improving motion, strength, and pain relief [5], with the GUEPAR II implant specifically demonstrating high degrees of pain relief [40]. While total joint replacement offers advantages such as restoration of thumb length, alignment, and faster recovery, it is technically demanding and carries a potentially higher complication rate [37]. Suture suspension arthroplasty provides comparable clinical results to other techniques with distinct advantages, including shortened operative time, inherent stability of thumb metacarpal height, and no requirement for K-wire fixation, tendon transfers, or implants [6, 7]. This procedure is considered simple, reliable, low morbidity, and cost-effective, yielding good to excellent long-term outcomes [11, 21]. Patients undergoing suture suspension achieve excellent long-term results despite some radiographic subsidence over time [2]. Trapezio-metacarpal arthroplasty remains a long-term reliable solution with a limited complication rate [23].

Despite satisfactory implant survivorship in register studies, current evidence does not support widespread implementation of thumb CMC replacements [14]. Outcomes vary significantly by implant; the Moje Acamo CMC implant has shown results clearly inferior to other implants and trapezectomy, leading to its discontinuation in some clinics [38]. Complications can include persistent pain requiring reoperation, as seen in one case converted to arthroplasty after 4.4 years following autologous chondrocyte transplantation [1]. A review of hand joint arthroplasty notes that while pain relief is generally good, high rates of deformity recurrence and complications exist depending on the implant type and joint involved [20]. For complicated cases, a new technique using first carpometacarpal joint suspension arthroplasty with palmaris longus tendon graft adds an option, though indications are limited [16].

Current trends indicate that while limited resection interposition (LRTI) predominates, nonprosthetic arthroplasty is the only cohort increasing in utilization [61]. There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA [4], although studies on prosthetic total joint replacement are increasing in number and quality [9]. Patient factors, including prior surgical experience and surgeon attitudes, strongly influence the odds of undergoing surgery [15]. Given similar 1-year postoperative outcomes for tendon arthroplasty and total joint replacement, it is crucial to examine comparative efficacy, long-term outcomes, and potential complications for each approach [22]. Adjunctive interventions include thumb CMC denervation, which provides durable pain relief in more than half of patients at 5+ years [10], though clinical results are generally disappointing and it is not widely accepted [33]. Arthroscopic-assisted techniques remain limited but may be reasonable for patients unresponsive to non-operative treatment [28]. Additionally, a home-based video-assisted therapy program was noninferior to in-person hand therapy for upper extremity function after arthroplasty [12].

Anatomy & Pathophysiology

Epidemiology and Demographics

Thumb carpometacarpal (CMC) arthritis is the second most common location for osteoarthritis in the upper limb after the distal interphalangeal joints [26]. Postmenopausal women represent the most common patient demographic, with 40% to 57% exhibiting radiographic evidence of disease [26]. Significant joint involvement is observed in 10% of middle-aged women and 25% of men over 75 years of age [26]. The prevalence of primary osteoarthritis in the trapeziometacarpal (TMC) joint is reported to be as high as 15% in adults over age 30 [182]. As many as one-third of postmenopausal women are affected by primary osteoarthritis of the TMC joint [182].

Clinical Presentation and Pathology

Thumb CMC arthritis causes pain and weakness with the essential movements of the first metacarpal-trapezial joint: opposition, key pinch (prehension), and circumduction [26]. Pain is localized to the base of the thumb but may radiate proximally to the radial forearm [26]. Synovitis and effusion of early disease may be associated with thenar tenderness and first webspace cramping [26]. As the disease progresses, associated subjective instability and objective deformity are noted as the shoulder sign, or the radial prominence of the dorsally subluxed first metacarpal [26].

Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes [89]. Thumb carpometacarpal joint osteoarthritis reflects the joint's teleology, where pathomechanics drive inflammatory markers and injury to soft tissue structures rather than simple wear and tear [126]. Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis [105].

Thumb metacarpophalangeal instability is commonly found in conjunction with trapeziometacarpal osteoarthritis [80]. If not corrected, thumb metacarpophalangeal instability can have detrimental effects on the outcome [80]. Two types of metacarpophalangeal deformities are described in the context of trapeziometacarpal osteoarthritis: hyperextension and valgus [80].

Biomechanics and Kinematics

The trapeziometacarpal (TMC) joint provides the different movements of opposition [29]. During thumb oppositional motion, internal rotation of the first metacarpal occurred, with the palmar base rotating primarily with respect to the dorsal base [96]. Dorsal translation of the center of rotation in flexion-extension is a kinematic characteristic of the arthritic TM joint [109]. Radial translation in abduction-adduction is not a kinematic characteristic of the arthritic TM joint [109]. Thumbs in patients with TMC-OA and healthy thumbs have different kinematics during FDI maneuvers [95]. An atrophic FDI may not be an efficient dynamic stabilizer [95].

Thumb motion capability was unaffected by sex and handedness [86]. Directionally coupled motion patterns in the CMC joint are similar in men and women [111]. The decrease in key pinch force was larger than the relatively small increase in thumb CMC force in a cadaver model of thumb trapeziectomy and flexor carpi radialis suspensionplasty [8]. Wrist biomechanics were significantly altered following trapeziectomy [84]. Of the reconstructions tested, LRTI most closely resembled the intact biomechanics in a cadaveric model [84]. Total joint arthroplasty is able to restore thumb function but cannot fully replicate the kinematics of the healthy TMC joint [85]. The dominant postoperative effect of first metacarpal extension osteotomy was palmar loading with reduced dynamic variability [112]. A rationale for a dynamic stabilization approach is presented based on the unique anatomy of the thumb [45].

Functional Assessment

A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA [17]. Gross grasp is not associated with early thumb CMC OA [17]. Cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages [17]. Thumb abduction can be measured with simple standard commercial instruments, hand-held dynamometers, with the forearm and wrist in neutral, the ulnar border supported on a table and the dorsal surface stabilized against a wall [90]. The inter-metacarpal distance method is currently the most reliable tool for measuring thumb abduction [92]. Three-dimensional assessment of thumb kinematics can enhance understanding of expected outcomes and aid in postoperative assessment and patient education [87]. Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage OA [43].

Anatomical Structures and Imaging

Anatomical studies have identified two annular and one oblique pulley in the thumb [120]. The 1R portal for thumb CMC joint arthroscopy is just radial to the APL tendon and passes through the nonligamentous capsule just lateral to the AOL [130]. The 1U portal for thumb CMC joint arthroscopy is located just ulnar to the EPB tendon and passes between or through the DRL and POL [130]. There is no true internervous plane for thumb CMC joint arthroscopy because branches of the SRN surround the posterior and are at risk for injury [130]. The radial artery courses immediately posterior and ulnar to the arthroscopic field of the thumb CMC joint [130].

The correct placement of the arthroscope into the thumb CMC joint can be confirmed with the concave saddle appearance of the trapezium [128]. If the arthroscope is inserted into the STT joint, the scaphoid will be immediately recognized by its convex, dome-shaped articular surface [128]. The thenar portal for thumb CMC joint arthroscopy is created through the radial border of the thenar muscle and is approximately 90 degrees from the 1U portal [130]. The terminal branches of the motor branch of the median nerve (MBMN) were all located in the proximal third of the thenar muscles, where the thenar portal was introduced [130]. Five (35.7%) of 14 fresh-frozen specimens indicated the superficial branch of the MBMN laid directly over the thenar portal [130].

The distal dorsal (D2) accessory portal is situated in the dorsal aspect of the first web space ulnar to the EPL tendon and 1 cm distal to the V-shaped soft spot at the junction of the index and thumb metacarpal bases [130]. There is no true safe zone for the D2 portal due to the nearby dorsal branch of the radial artery [130]. The deep anterior oblique (palmar oblique), dorsal radial, and posterior oblique ligamentous structures are involved in thumb CMC joint stability [55]. In most cases of isolated thumb CMC joint dislocation, the ligaments are avulsed off the metacarpal base with a periosteal sleeve [55].

Trauma and Injury Patterns

Thumb metacarpal base fractures with associated subluxation or dislocation of the CMC joint account for nearly 80% of thumb CMC injuries [44]. With the exception of nondisplaced fractures without dislocation/subluxation of the CMC joint, these injuries require surgical intervention [44]. Isolated thumb CMC joint dislocations are rare [55]. Management of isolated thumb CMC joint dislocations should include a closed reduction [55]. If stable after reduction, a trial of splinting can be performed but is often unsuccessful and rarely recommended [55]. Surgical repair of the capsuloligamentous structures of the thumb can result in a stable joint [55].

For Bennett's fractures, the most common pin configuration is stabilizing the metacarpal to the adjacent index metacarpal, pinning the fracture fragment to the metacarpal, and placing an additional pin from the intact metacarpal base into the trapezium [44]. In larger fracture fragments with greater than 20% to 25% of the surface area, an open reduction and lag screw fixation can be accomplished with K-wire supplementation for neutralization of the joint-reactive forces [44]. The crucial goal in treating thumb CMC joint dislocations with fracture is concentric reduction of the joint [44]. In cases with more significant intra-articular comminution, such as Rolando fractures, an indirect reduction with longitudinal traction is often needed [44]. If the joint cannot be reduced with ligamentotaxis, a small incision can be made and a small elevator used to mold the pieces to the surface of the trapezium and then the metaphysis is backfilled with cancellous chips [44].

K-wires into the trapezium itself are often not helpful in cases of severe comminution as the fragments are often too small [44]. In cases where the fragments are large enough, either K-wires or an ORIF may be used [44]. The fragments must be large enough to hold 1.5-, 1.7-, 2.0-, or 2.3-mm screws [44]. The Wagner approach can be used for the reduction, as a dorsal approach does not allow access both volarly and dorsally to the joint [44]. A dorsal T-plate can be placed with eccentric drilling used to accomplish compression of the fragments [44]. Plates with locking screws are helpful to neutralize the bending forces and to achieve adequate purchase in the cancellous bone of the proximal metaphyseal base [44].

If fixation is adequate, early range of motion may be started but pinch is often restricted until adequate healing is identified on radiographs [44]. In cases in which screw fixation cannot be accomplished, smaller K-wires (0.035) can be placed into the fragments or subchondrally to prevent subsidence [44]. If there is severe comminution, a bridging external fixator is indicated [44]. The fixator pins are engaged into the distal diaphysis of the thumb metacarpal and connected to either the trapezium or radius (unilateral construct) or to the index metacarpal (triangular or quadrilateral construct) [44]. Although posttraumatic arthritis may ensue, clinical results are usually good [44]. If there is subsequent arthrosis and pain, CMC arthroplasty provides excellent outcomes if a salvage procedure is needed [44].

Classification

Radiographic Staging Reliability

The Eaton-Littler classification system for radiological osteoarthritis of the first carpometacarpal joint demonstrates moderate interobserver agreement among radiologists and hand surgeons [140]. However, the system has shown low intraobserver and interobserver reliability [155]. A systematic review of the literature indicates that while radiographs assist in assessing CMC joint disease, there is not a reliable system for classifying disease severity [27]. Consequently, the radiological classification of carpometacarpal joint osteoarthritis does not describe all stages accurately enough to permit reliable and consistent communication between clinicians [70].

Anatomical and Structural Classification

The Eaton–Glickel classification utilizes a four-stage system for a three-dimensional analysis of osteoarthritic changes in the thumb carpometacarpal joint by evaluating osteophytes, joint space narrowing, osteosclerosis, subluxation, and cystic changes [154]. In Eaton stage IV, there are similar destructive changes in the scaphotrapezial joint [154]. A separate staging system for CMC-OA degeneration grades cartilage lesions on a five-point scale based on location and degree of damage across six anatomical areas of the trapezium and metacarpal [158]. Additionally, the metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens [149].

Clinical and Functional Considerations

Ulnar instability should be included in the classification of thumb CMC joint osteoarthritis stages and considered in treatment options [132]. Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage osteoarthritis [43].

Clinical Presentation

Symptoms and Functional Deficits

Pain in thumb carpometacarpal (CMC) arthritis is localized to the base of the thumb, though it may radiate proximally to the radial forearm [26]. Functional deficits are specific to early disease; a reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA [17]. Pinch strength is less in patients with early thumb CMC OA compared to asymptomatic control subjects [102]. Among key, tripod, and tip pinch positions, key pinch had the most robust association with early thumb CMC OA diagnosis [102]. Clinicians must note that self-reported pain, weakness, and physical examination may not correspond to radiographic findings when diagnosing early thumb CMC OA [102].

Physical Examination and Diagnostic Tests

The diagnosis of thumb CMC joint arthritis is heavily dependent on physical examination [114]. The grind test is performed by circumducting the thumb metacarpal while compressing the joint axially and is considered positive if it elicits pain [114]. However, a negative grind test does not necessarily reflect negative radiographic evidence of thumb CMC osteoarthritis [68]. From a therapist’s standpoint, there is a lack of accuracy and a relatively high incidence of false negative results for the grind test in CMC arthritis [114]. The specificity of the thumb CMC Grind test has been reported to be between 80% and 93%, and the sensitivity between 42% and 53% [54].

Alternative manoeuvres offer varying diagnostic accuracy. A recent study concluded that adduction and extension manoeuvres are more accurate than the grind test for diagnosing CMC arthritis [114]. Choa et al. demonstrated a ‘traction-shift’ test as a superior method of diagnosing CMC arthritis compared with the grind test [114]. The reduction manoeuvre was more sensitive and specific than the grind or shift tests for diagnosing CMC arthritis [114].

Radiographic and Imaging Findings

Radiographs assist in the assessment of CMC joint disease, but there is not a reliable system for classification of disease severity [27]. Subjects presenting with early CMC OA had significantly lower bone density as assessed with HU at the thumb CMC joint (trapezium and first metacarpal base) [53]. The Eaton-Littler radiographic classification is used to determine preoperative severity of trapeziometacarpal osteoarthritis [25]. The Eaton classification of thumb CMC arthritis was used to assess preoperative and postoperative radiographic disease at the CMC joint [49].

Demographics and Prevalence

Thumb CMC arthritis is the second most common location for osteoarthritis in the upper limb after the distal interphalangeal joints [26]. Postmenopausal women are the most common thumb CMC arthritis patients, with 40% to 57% exhibiting radiographic evidence of disease [26]. Middle-aged women have significant joint involvement at 10% [26]. Men over 75 years of age have significant joint involvement at 25% [26].

Investigations

Clinical Assessment

The thumb CMC Grind test demonstrates a reported specificity between 80% and 93% and a sensitivity between 42% and 53% [54]. The Thumb Disability Examination (TDX) serves as a precise and valid outcome measure for individuals with a clinical diagnosis or indications of thumb CMC OA [34]. Utilizing outcome measures and treatments tailored to the unique impact of thumb carpometacarpal osteoarthritis (CMC1 OA) is likely to improve outcomes [60].

Radiographic Assessment

Plain radiography: The radiological classification does not describe all stages of carpometacarpal joint osteoarthritis accurately enough to permit reliable and consistent communication between clinicians [70]. The modified thumb CMC stress view radiograph evaluates laxity and joint abnormalities of the trapeziometacarpal articulation with high inter- and intra-observer reliability for radial subluxation and first metacarpal width [184]. Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy [161]. Radiographic development of trapeziometacarpal arthrosis is an expected part of human aging, although clinically significant, functionally limiting trapeziometacarpal arthrosis is less common, and its development may be unrelated to hand use [187]. Advanced radiographic arthritis, current smoking status, and a history of ipsilateral hand surgery were patient-specific factors that predicted progression to surgery following injection [188].

Other Imaging and Diagnostic Modalities

Bone scan: Bone scan uptake after trapeziometacarpal joint arthroplasty progressively decreases over time, with normalization of tracer uptake expected between 14 and 25.5 months after surgery [172].

Other Considerations: Image-guided thumb CMC injections do not result in significant increases in time between injections and do not lead to a meaningful delay to surgery [63]. Novel technologies such as 3D printed braces, image-guided injections, and advanced surgical techniques show promise in precision and patient satisfaction, but they are not yet established as superior to standard treatments of thumb CMC OA [185].

Treatment

Non-Operative

Nonsurgical management remains the initial reasonable treatment for thumb base osteoarthritis regardless of disease stage [123]. Nonoperative modalities are effective for early stages, while surgical options are reserved for cases refractory to conservative measures [19]. However, non-operative treatment has not been thoroughly explored, and surgery may have a strong placebo effect, requiring further evaluation through pragmatic trials comparing surgery versus no surgery or placebo arms [131].

Operative

Indications: There is a lack of consensus on critical outcomes after surgery for thumb CMC joint osteoarthritis [4]. No surgical intervention was superior to the other for treating the first CMC joint osteoarthritis [129]. Randomized clinical trials of CMC arthrodesis and total joint prostheses compared to trapeziectomy with long follow-up (≥1 year) are warranted [69]. The TDX is a precise and valid outcome measure for individuals having a clinical diagnosis or indications of having thumb CMC OA [34].

Surgical Approach / Technique: Total trapeziectomy is currently the only surgical technique for thumb basal joint arthritis that can lay claim to being a potential life-long procedure without the need for an implant [133]. Trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis [57]. Partial trapeziectomy with capsular interposition arthroplasty results in a stable thumb with pain relief [136]. Partial arthroscopic trapeziectomy with ligament reconstruction is a reliable procedure with low morbidity, recommended only for isolated thumb CMC arthritis without scaphoid-trapezium joint degeneration [30]. The "Pillow" technique for thumb CMC joint arthritis provides pain relief and satisfactory function at an average of 12.5 years after surgery [167]. Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis resulted in complete relief of pain in 30 hands (83.6%) [164]. Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint is indicated when disease is limited to the trapeziometacarpal joint, whereas degenerative changes in both the trapeziometacarpal and scaphotrapezial joints are an indication for trapezium replacement arthroplasty [169].

Ligament Reconstruction and Suspensionplasty: The TESS technique appears to be technically reproducible and achieves objectively and subjectively similar results to other reported procedures used to manage first CMC arthritis [122]. The Tightrope procedure should be considered as an option for patients needing thumb CMC arthroplasty due to reduced healing time, reduced weeks of immobility, and fewer therapy visits [66]. A new technique of first carpometacarpal joint suspension arthroplasty with palmaris longus tendon graft adds an additional option for complicated cases of thumb base arthritis, although indications are limited [16]. Abductor pollicis longus suspension ligamentoplasty for treatment of advanced first carpometacarpal arthritis provided excellent pain control with a mean VAS score of 1.7 and allowed patients to return to occupational activities [180]. The suture suspension arthroplasty technique is typically performed under regional anesthesia and takes approximately 25 to 30 minutes to perform [170]. In the surgical technique for ligament reconstruction and tendon interposition, it is essential that the position of the thumb in space, and therefore the size and position of the arthroplasty, is precise to ensure maximum function with the least stress on the new "ligament" [75]. The decrease in key pinch force was larger than the relatively small increase in thumb CMC force in a cadaver model of thumb trapeziectomy and flexor carpi radialis suspensionplasty with thumb metacarpophalangeal hyperextension [8]. Salvage options exist for stabilizing the base of the thumb metacarpal when the flexor carpi radialis tendon is deficient or injured during ligament reconstruction and tendon interposition or suspension arthroplasty [177].

Implant Selection: Despite relatively satisfactory implant survivorship in the Norwegian Arthroplasty Register study, current evidence does not support widespread implementation of thumb CMC replacements [14]. The results of treating osteoarthritis of the thumb CMC joint with the Moje Acamo CMC implant have been clearly inferior to other implants and trapezectomy, leading to discontinuation of the procedure in the reporting clinic [38]. Trapezial-metacarpal joint replacement using an ARPE implant provides excellent pain relief, good function, and in the event of failure, uncomplicated potential for salvage [144]. Two case reports presented successful total exchange arthroplasty at the carpometacarpal joint of the thumb using an ARPE implant [147]. Given that 1-year postoperative outcomes are similar for both tendon arthroplasty and total joint replacement, it is crucial to delve into the comparative efficacy, long-term outcomes and potential complications associated with each surgical approach [22]. The authors advocate that routine retrieval and analysis of failed trapeziometacarpal joint implants be considered essential practice within hand surgery [135]. Prosthetic replacement is preferred in case of loosening when it is technically possible in order to preserve the thumb’s length during revision procedures [143].

Arthrodesis: Thumb carpometacarpal arthrodesis provides excellent strength, satisfactory thumb range of motion, and excellent patient satisfaction [32].

Denervation: Thumb CMC denervation is a treatment option for patients not responding to nonsurgical management, though its long-term durability is not yet established and it has not been included in systematic reviews comparing surgical options [134]. The treatment approach of denervation, joint lavage and capsular imbrication could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis, with advantages including a low rate of complications, low invasiveness, and short recovery times [116].

Arthroscopic Techniques: Suture button suspensionplasty after arthroscopic hemitrapeziectomy allows for early mobilization and may offer a potential improvement on current techniques that require pinning of the thumb ray for 4 weeks [175].

Complications and Revision: The article reviews the most common complications after surgery for basal thumb arthritis, emphasizing resection arthroplasty, joint replacement, and joint fusion, and highlights possible management strategies for the different types of complications [18]. Revision of trapeziectomy failures in thumb base osteoarthritis has been analyzed in a retrospective study of ten cases [178]. Perioperative and early postoperative complications for trapeziometacarpal total joint arthroplasty included fractures of the trapezium in three patients, two excessive trapezium osteotomies (both failed), and one stem penetration of the cortex of the thumb metacarpal [48]. Late complications for trapeziometacarpal total joint arthroplasty included cup loosening in ten patients (4.6%) and dislocation of twelve prostheses (5.3%) [48]. The frequency of small trapeziums was higher in failed cases (12 out of 16) than in functional outcomes (30 out of 200) for trapeziometacarpal total joint arthroplasty [48]. Several patients developed a mass superficial to the CMC joint after surgery, which turned out to be interposition material extruded from the resected CMC joint [35].

Pain Management: Continuous local anaesthetic infusion following trapeziectomy was used as a routine for 3 years on 40 patients [166].

Rehabilitation: A home-based video-assisted therapy program is noninferior to in-person hand therapy for upper extremity function after thumb CMC arthroplasty [12]. Multiple therapy programs exist and rehabilitation following thumb CMC arthroplasty predominantly utilizes clinical expertise [24]. After interposition arthroplasty of the thumb followed by two weeks cast fixation, a thermoplastic short orthotic thumb device should be used [151]. Pain relief and improved hand function appear to be key determinants of patient satisfaction after dual-mobility trapeziometacarpal joint implant arthroplasty [176].

Complications

General Complication Rates and Risk Factors: Total joint replacement for thumb CMC osteoarthritis is technically demanding with a potentially higher complication rate [37]. Many thumb CMC implant arthroplasties have been associated with high complication rates, including aseptic loosening and subsidence, subluxation and dislocation, periprosthetic fracture, and infection [139]. CMC arthroplasty has an overall complication rate of 1.3% and a wound complication rate of 0.66% [186]. Patients who receive an intra-articular corticosteroid injection within 3 months before surgery for CMC joint arthritis may be at increased risk of repeat surgery to treat a wound complication or infection in the 90-day postoperative period [199]. Preoperative CMCJ steroid injection status does not affect major complication rates or functional outcomes following CMCJ arthroplasty [196]. The intermediate term (5 years minimum) rate of reoperation following thumb basal joint arthroplasty for any reason was 2% [77]. Approximately one-fourth of reoperation cases following thumb basal joint arthroplasty required revision arthroplasty for symptomatic subsidence or instability [77]. Unplanned early reoperation rates following thumb basal joint arthroplasty are lower than those published previously [148]. Suture button suspensionplasty for CMC arthroplasty with intermediate follow-up revealed excellent clinical outcomes and low complication rates [82]. Suture suspension arthroplasty is a simple, reliable, low morbidity, and cost-effective method for thumb CMC arthritis reconstruction [21]. The recommendation for resection-interposition arthroplasty over trapeziometacarpal arthrodesis and Silastic replacement was made purely on the basis that the resection-interposition group had the lowest complication rates [145].

Infection (PJI): In a series of 97 patients with 138 anterior trapezectomies, wound infection occurred in one patient [150]. There was no evidence of deep infection in a 10-year follow-up series of thumb CMC arthroplasty [48].

Aseptic Loosening: Aseptic cup loosening is the most common reason for implant failure in thumb CMC replacement arthroplasty, leading to revision rates of 42%–51% [138]. Late complications in a 10-year follow-up series included cup loosening in ten patients (4.6%) [48]. Two cases of cup loosening were successfully treated with cup revision in addition to autologous bone grafting [48]. No complete loosening of the stem was present in a 10-year follow-up series [48]. Three implants showed partial radiolucency proximally in a 10-year follow-up series [48]. Loosening of the prosthesis is a leading cause of poor outcome in arthroplasty, usually attributed to mechanical failure, prosthetic fracture, prosthetic malposition, soft tissue imbalance, or excessive joint laxity [88].

Instability: Twelve prostheses (5.3%) dislocated in a 10-year follow-up series [48]. Seven of the dislocated prostheses were resolved by closed reductions in four cases and open reductions in three cases [48]. Five dislocated prostheses remained dislocated at the final follow-up and were offered reconstructive surgery [48].

Periprosthetic Fracture: In a series of 199 patients with a minimum of 10 years follow-up, perioperative and early postoperative complications included fractures of the trapezium in three patients [48]. In the same series, two excessive trapezium osteotomies occurred, both of which failed [48]. In the same series, one stem penetration of the cortex of the thumb metacarpal occurred, which remained functional in situ without evidence of loosening during follow-up [48].

Nerve Palsy: Thirteen patients in a 10-year follow-up series complained of moderate paraesthesia or dysesthesia dorsally on the thumb [48]. Two patients with dorsal paraesthesia or dysesthesia reported persistent symptoms at the 10-year review [48]. Hyperesthesia in the territory of the palmar cutaneous branch of the median nerve was observed in three patients in a series of anterior trapezectomies [150].

Wound Complications: There were five cases of suture reaction in a 10-year follow-up series of thumb CMC arthroplasty [48]. Mild tenderness of the scar was observed in seven patients in a series of anterior trapezectomies [150].

Stiffness / Arthrofibrosis: Three patients in a 10-year follow-up series experienced transient complex regional pain syndrome type I [48]. Swelling of the hand in nineteen patients after anterior trapezectomy was considered by the authors to represent CRPS I [150]. All but seven patients with CRPS I after anterior trapezectomy had full recovery [150]. One patient with CRPS I after anterior trapezectomy had permanent pain and a fair result [150]. Six patients with CRPS I after anterior trapezectomy retained a mild lack of flexion of the index finger but finally had a good result [150]. The lack of flexion of the index finger in CRPS I cases after anterior trapezectomy might be explained by the formation of adhesions between the sheath of FCR and the index flexor tendons after release of the carpal tunnel [150]. The rate of CRPS I in a series of anterior trapezectomies was superior to the rates reported in other series of trapeziometacarpal joint arthritis [150]. This higher rate of CRPS I might be attributed to the “double” operation of carpal tunnel release and trapeziectomy [150].

Other Considerations: Despite relatively satisfactory implant survivorship in a Norwegian register study, current evidence does not support widespread implementation of thumb CMC replacements [14]. Commonly reported complications following trapeziectomy and ligament reconstruction with tendon interposition include complex regional pain syndrome, scar contracture/tenderness, nerve injury, thumb metacarpal base instability, uncorrected hyperextension deformity of the metacarpophalangeal joint, and wound infections [141]. Persistent thumb basilar pain after surgical treatment of TM OA may be attributed to concomitant scaphotrapezoidal and/or scaphotrapezial arthritis [141]. The frequency of small trapeziums (12 out of 16) in the failed cases was higher than in functional outcomes (30 out of 200) in a 10-year follow-up series [48]. Nine prostheses failed in the initial 104 CMC joints and seven occurred in the remaining 124 CMC joints after a change in surgical technique [48]. One thumb CMC joint treated with autologous chondrocyte transplantation was still painful and was reoperated and converted to arthroplasty after 4.4 years [1]. Surgeons should be aware of the potential complication of failed suture button suspensionplasty when using this device to treat thumb carpometacarpal arthritis [67]. Failed suture button suspensionplasty of the thumb carpometacarpal joint can be salvaged using pyrocarbon arthroplasty [67]. To protect the prosthesis after thumb CMC arthroplasty, patients are discouraged from lifting more than 2 lb regularly and no more than 10 lb [88]. The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results [83]. Although 68% of patients indicated that their thumb was better than before primary surgery, the outcome after revision surgery was less favourable than that reported for primary trapeziectomy with ligament reconstruction and tendon interposition [78]. The results after revision surgery for interposition implant trapeziometacarpal arthroplasty may be worse than previously described, and there may also be a tendency for worse results than those of primary arthroplasty [197]. Of 174 thumb CMC pyrocarbon arthroplasties performed over 16 years, 22 patients with 23 implants underwent revision to trapeziectomy [91]. One additional patient underwent the resection of bilateral pyrocarbon implants placed at a different institution, leading to a cohort of 25 pyrocarbon removals in 23 patients [91]. The average time between primary pyrocarbon arthroplasty and the explant procedure was 18.8 months (SD, 12.2) [91]. The most common reason for the removal of the pyrocarbon implant was the development of symptomatic STT osteoarthritis [91]. Handgrip strengths and key pinch strength of the two hands were comparable after secondary trapeziectomy following failed trapeziometacarpal joint replacement [50]. It is unclear how longer follow-up after revision surgery would affect metacarpal subsidence, but a lack of metacarpal subsidence was observed past 5 years in most patients in a revision study [42]. The difference in the radial abduction and palmar abduction of the thumb after revision surgery may be clinically irrelevant because it may reflect measurement error for a handheld goniometer [42]. There was no control group in a revision CMC arthroplasty cohort, and further study is needed to determine the ideal treatment for revision CMC arthroplasty [42]. Surgeon discretion is required to determine the cause and best possible treatment for symptomatic patients following failed thumb CMC arthroplasty [42]. The study established consensus recommendations for six common revision scenarios using a rigorous Delphi process involving experienced hand surgeons worldwide [200]. This study demonstrated that 1 in 6 thumbs underwent secondary TMC arthroplasty, an average of 11 months after the initial arthroscopy [193].

Recovery

Light activity (weeks): The evidence provided does not specify a defined week range for the resumption of desk work, driving, or light activities of daily living.

Full activity (months): The evidence provided does not specify a defined month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The evidence provided does not specify a defined month range for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: Rehabilitation following thumb CMC arthroplasty predominantly utilizes clinical expertise, with multiple therapy programs existing for this purpose [24]. Postoperative immobilization is a primary driver of sick leave [76]. Suture suspension thumb CMC arthroplasty offers inherent stability of the thumb metacarpal height and eliminates the necessity for K-wire fixation, tendon transfers, or implants [7]. The Tightrope procedure is associated with reduced healing time, reduced weeks of immobility, and fewer therapy visits, suggesting it should be considered as an option for patients needing thumb CMC arthroplasty [66]. Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of the procedure [165].

Functional milestones: No validated patient-reported outcome measure trajectories or specific outcome-measure benchmarks (such as Constant, ASES, or WOMAC scores) are provided in the evidence for this section.

Other Considerations: Patients undergoing surgery for thumb CMC osteoarthritis often require sick leave owing to postoperative immobilization, pain, and decreased function [76]. Surgical subjects experienced a pronounced increase in sick leave in the first 2 months after surgery, followed by diminishing days of leave over time [76]. Mean sick leave time after soft tissue arthroplasty was 202 days in women and 170 days in men [76]. Following prosthetic arthroplasty, mean sick leave was 177 days in women and 188 days in men [76]. When excluding those with documented sick leave in the month before surgery, the mean postoperative sick leave decreased to 137 days in women and 125 days in men after soft tissue arthroplasty [76]. A history of depression may not adversely affect patient-reported outcomes after thumb CMC arthroplasty [58]. First ray subsidence is a common factor in failed thumb basal joint resection arthroplasty [81]. However, a relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear in modified suture suspension arthroplasty [190]. Approximately one-fourth of reoperation cases following thumb basal joint arthroplasty require revision arthroplasty for symptomatic subsidence or instability [77]. The outcome after revision surgery for failed thumb carpometacarpal resection arthroplasty was less favourable than that reported for primary trapeziectomy with ligament reconstruction and tendon interposition [78]. Despite this, 68% of patients indicated that their thumb was better than before primary surgery following revision of thumb carpometacarpal resection arthroplasty [78]. Trapeziectomy with an alternative suspension technique for treatment of carpometacarpal thumb joint osteoarthritis shows poor patient-reported outcome measures after secondary surgery [194].

Key Evidence

• [L4] One thumb CMC joint was still painful and was reoperated and converted to arthroplasty after 4.4 years. [1] (10.1016/j.hansur.2020.11.008)
• [L4] Patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. [2] (10.1016/j.jhsg.2023.12.002)
• [L1] There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. [4] (10.1016/j.jhsa.2020.05.024)
• [L4] In our series, total joint arthroplasty of the thumb CMC joint has proven to be efficacious with improved motion, strength, and pain relief. [5] (10.1016/j.jhsa.2006.08.008)
• [L4] Suture suspension thumb CMC arthroplasty appears to provide equal clinical results and several advantages over many current techniques, including shortened operative time, inherent stability, and no requirement for K-wire fixation, tendon transfer, or implants. [6] (10.1016/j.jhsa.2018.06.084)
• [L4] Suture suspension thumb CMC arthroplasty provides comparable clinical results and several advantages over many current techniques, including shortened operative time, inherent stability of the thumb metacarpal height, and no necessity for K-wire fixation, tendon transfers, or implants. [7] (10.1016/j.jhsa.2019.02.005)
• [L5] The decrease in key pinch force was larger than the relatively small increase in thumb CMC force. [8] (10.1016/j.jhsa.2022.11.018)
• [L1] Studies reporting outcomes in thumb CMCJ prosthetic total joint replacement are increasing in both number and quality. [9] (10.1302/2058-5241.6.200152)
• [L4] Thumb CMC denervation provides effective relief of arthritis pain that was durable at 5+ years after surgery in more than half of the initial cohort of patients treated. [10] (10.1016/j.jhsg.2022.02.005)
• [L4] The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes. [11] (10.1177/15589447211003176)
• [L1] VOT was noninferior to IPT for upper extremity function after thumb CMC arthroplasty. [12] (10.2106/jbjs.23.00597)
• [L3] Despite relatively satisfactory implant survivorship in our register study, current evidence does not support widespread implementation of thumb CMC replacements. [14] (10.1177/1753193413513988)
• [L4] Instead, patients' prior surgical experience and surgeon attitudes toward thumb CMC arthritis appear to have a strong influence on the odds of patients undergoing surgery for thumb CMC arthritis. [15] (10.1016/j.jhsa.2021.02.009)
• [L5] Although indications for this technique are limited, we believe it adds an additional option for complicated cases of thumb base arthritis. [16] (10.1097/bth.0000000000000045)
• [L3] A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA, suggesting that cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages. [17] (10.1007/s11999-016-5151-2)
• [L5] The article reviews the most common complications after surgery for basal thumb arthritis, emphasizing resection arthroplasty, joint replacement, and joint fusion, and highlights possible management strategies for the different types of complications. [18] (10.1177/17531934231197787)
• [Paper] Degenerative arthritis of the thumb CMC joint is a common treatable condition where nonoperative modalities are effective for early stages, while surgical options are reserved for cases refractory to conservative measures. [19] (10.1016/j.hcl.2008.03.001)
• [L4] The review describes various arthroplasty possibilities, indications, and surgical techniques for hand joints, noting that while pain relief is generally good, there are high rates of deformity recurrence and complications depending on the implant type and joint involved. [20] (10.1177/17531934211017703)
• [L4] Suture suspension arthroplasty is a simple, reliable, low morbidity, and cost-effective method for thumb CMC arthritis reconstruction with long-term outcomes similar to other trapeziectomy procedures. [21] (10.1016/j.jhsa.2015.06.053)
• [L5] Given that 1-year postoperative outcomes are similar for both tendon arthroplasty and total joint replacement and given the complexity of thumb arthritis and the diversity of patients’ needs, it is crucial to delve into the comparative efficacy, long-term outcomes and potential complications associated with each surgical approach. [22] (10.1177/17531934231206267)
• [L4] Trapezio-metacarpal arthroplasty is a long-term reliable solution for surgical treatment of thumb carpometacarpal osteoarthritis, with a limited complication rate. [23] (10.1016/j.hansur.2019.10.097)
• [L4] This study demonstrates that multiple therapy programs exist and rehabilitation following thumb CMC arthroplasty predominantly utilizes clinical expertise. [24] (10.1016/j.jht.2020.10.016)
• [L3] [25] (10.1016/j.jhsa.2008.04.028)
• [L5] [26] (10.1016/j.hcl.2010.05.006)
• [L1] Review of the literature demonstrates that radiographs assist in the assessment of CMC joint disease, but there is not a reliable system for classification of disease severity. [27] (10.1007/s11999-013-3208-z)
• [L1] The use of arthroscopic-assisted techniques for thumb CMC OA is still limited; however, it may be a reasonable option for patients with thumb CMC OA who do not respond to non-operative treatment. [28] (10.1177/1753193418757122)
• [L4] [29] (10.1016/j.jhsa.2019.11.015)
• [L4] It is a reliable procedure with low morbidity, recommended only for isolated thumb CMC arthritis without scaphoid-trapezium joint degeneration. [30] (10.1016/j.otsr.2012.05.018)
• [L5] It provides excellent strength, satisfactory thumb range of motion, and excellent patient satisfaction. [32] (10.1097/00130911-200212000-00004)
• [L5] The clinical results of thumb CMC denervation are disappointing, and it is not currently a widely accepted procedure. [33] (10.1016/j.hansur.2020.09.011)
• [L4] The TDX is a precise and valid outcome measure for individuals having a clinical diagnosis or indications of having thumb CMC OA. [34] (10.1016/j.jht.2021.07.002)
• [Paper] They report that several patients developed a mass superficial to the CMC joint after surgery, which turned out to be interposition material extruded from the resected CMC joint. [35] (10.1016/j.jhsa.2011.05.012)
• [L5] Total joint replacement offers advantages over other surgical treatments, including restoration of thumb length and alignment, good cosmetic results, and faster recovery, though it is technically demanding with a potentially higher complication rate. [37] (10.1530/eor-22-0027)
• [L4] The results of treating osteoarthritis of the thumb CMC joint with the Moje Acamo CMC implant have been clearly inferior to other implants and trapezectomy, leading to discontinuation of the procedure in their clinic. [38] (10.1177/1753193408090759)
• [L4] In our series, GUEPAR II total joint arthroplasty of the thumb CMC joint has proven to be efficacious, improving motion, strength, and achieving a high degree of pain relief. [40] (10.1016/j.otsr.2008.06.001)
• [L4] [42] (10.1016/j.jhsa.2017.07.015)
• [L5] Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage OA. [43] (10.1016/j.jhsa.2007.02.009)
• [L5] A rationale for a dynamic stabilization approach is presented based on the unique anatomy of the thumb. [45] (10.1016/j.jht.2022.06.007)
• [L2] [48] (10.1177/1753193419871660)
• [L4] [49] (10.1016/j.jhsa.2018.01.005)
• [L4] Handgrip strengths and key pinch strength of the two hands were comparable. [50] (10.1016/j.hansur.2018.10.067)
• [L2] Subjects presenting with early CMC OA had significantly lower bone density as assessed with HU at the thumb CMC joint (trapezium and first metacarpal base). [53] (10.1016/j.jhsa.2017.09.004)
• [L4] [54] (10.1016/j.jht.2015.06.002)
• [L4] Trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis. [57] (10.1177/1753193412469127)
• [L4] These findings suggest that a history of depression may not adversely affect patient-reported outcomes after thumb CMC arthroplasty. [58] (10.1016/j.jhsg.2026.100989)
• [L4] Outcome measures and treatments tailored to the unique impact of thumb carpometacarpal osteoarthritis (CMC1 OA) are likely to improve outcomes. [60] (10.1002/acr.24124)
• [L2] Of surgical options to address thumb carpometacarpal arthritis, LRTI still predominates, but nonprosthetic arthroplasty was the only cohort increasing in utilization over the years. [61] (10.1016/j.jhsa.2025.03.014)
• [L3] Image-guided thumb CMC injections do not result in significant increases in time between injections and do not lead to a meaningful delay to surgery. [63] (10.1177/1558944719846572)
• [L4] The reduced healing time, reduced weeks of immobility, and fewer therapy visits following the procedure suggest that the Tightrope procedure should be considered as an option for patients needing thumb CMC arthroplasty. [66] (10.1016/j.jht.2013.12.012)
• [L4] Surgeons should be aware of this potential complication when using this device to treat thumb carpometacarpal arthritis. [67] (10.1016/j.jhsa.2017.03.017)
• [L3] However, a negative grind test does not necessarily reflect negative radiographic evidence of thumb CMC osteoarthritis. [68] (10.1016/j.jht.2010.02.001)
• [L1] However, randomized clinical trials of CMC arthrodesis and total joint prostheses compared to trapeziectomy with long follow-up (≥1 year) are warranted. [69] (10.1016/j.jhsa.2010.10.028)
• [L3] The radiological classification does not describe all stages of carpometacarpal joint osteoarthritis accurately enough to permit reliable and consistent communication between clinicians. [70] (10.1016/j.jhsa.2014.09.007)
• [L4] [75] (10.1016/j.hcl.2012.08.018)
• [L2] [76] (10.1016/j.jhsa.2017.11.019)
• [L4] The intermediate term (5 years minimum) rate of reoperation following thumb BJA for any reason was 2%, with only approximately one-fourth of reoperation cases requiring revision arthroplasty for symptomatic subsidence or instability. [77] (10.1016/j.jhsg.2023.12.013)
• [L4] Although 68% of patients indicated that their thumb was better than before primary surgery, the outcome after revision surgery was less favourable than that reported for primary trapeziectomy with ligament reconstruction and tendon interposition. [78] (10.1177/17531934211050559)
• [L4] [80] (10.1016/j.hansur.2020.05.013)
• [L5] The authors argue that while first ray subsidence is a poor proxy for success in trapeziectomy, it is a common factor in failed thumb basal joint resection arthroplasty. [81] (10.1177/17531934231217371)
• [L4] Results for a large series of SBS for CMC arthroplasty with intermediate follow-up revealed excellent clinical outcomes and low complication rates. [82] (10.1016/j.jhsg.2019.11.002)
• [L3] The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results. [83] (10.1016/j.jhsa.2013.01.030)
• [L5] Wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model. [84] (10.1016/j.jhsa.2019.10.003)
• [L4] We also showed that, whereas total joint arthroplasty is able to restore thumb function, it cannot fully replicate the kinematics of the healthy TMC joint. [85] (10.1016/j.jhsa.2017.10.011)
• [L3] Thumb motion capability was unaffected by sex and handedness. [86] (10.1016/j.jhsa.2014.08.012)
• [L3] Three-dimensional assessment of thumb kinematics can enhance understanding of expected outcomes and aid in postoperative assessment and patient education. [87] (10.1177/17531934251393568)
• [L5] [88] (10.1016/j.hcl.2012.08.025)
• [L5] Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes. [89] (10.5435/jaaos-d-17-00374)
• [L5] Thumb abduction can be measured with simple standard commercial instruments, hand-held dynamometers, with the forearm and wrist in neutral, the ulnar border supported on a table and the dorsal surface stabilized against a wall. [90] (10.1016/s0363-5023(98)80074-9)
• [L3] [91] (10.1016/j.jhsa.2022.01.004)
• [L4] Currently, it is the most reliable tool for measuring thumb abduction. [92] (10.1016/j.jht.2021.03.001)
• [L4] Thumbs in patients with TMC-OA and healthy thumbs have different kinematics during FDI maneuvers, and an atrophic FDI may not be an efficient dynamic stabilizer. [95] (10.1016/j.jhsa.2024.12.018)
• [L5] During thumb oppositional motion, internal rotation of the first metacarpal occurred, with the palmar base rotating primarily with respect to the dorsal base. [96] (10.1016/j.jhsa.2017.07.028)
• [L3] [102] (10.1007/s11999-015-4599-9)
• [L3] Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis. [105] (10.1177/17531934251383073)
• [L4] Dorsal translation of the center of rotation in flexion-extension but not radial translation in abduction-adduction is the kinematic characteristic of the arthritic TM joint. [109] (10.1016/j.jhsa.2003.11.002)
• [L4] Directionally coupled motion patterns in the CMC joint are similar in men and women. [111] (10.1007/s11999-013-3063-y)
• [L4] The dominant postoperative effect was palmar loading with reduced dynamic variability. [112] (10.1007/s00402-026-06455-5)
• [L3] [114] (10.1177/1753193419845290)
• [L4] The findings indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis, with advantages including a low rate of complications, low invasiveness, and short recovery times. [116] (10.1177/1753193416632149)
• [L5] Anatomical studies have identified two annular and one oblique pulley in the thumb. [120] (10.1016/s0363-5023(77)80101-9)
• [L4] The technique appears to be technically reproducible and achieves objectively and subjectively similar results to other reported procedures used to manage first CMC Arthritis. [122] (10.1097/bth.0000000000000046)
• [L5] The article reviews various surgical options for CMC arthritis, culminating in the delineation of the authors' preferred method, while noting that nonsurgical management is the initial reasonable treatment regardless of disease stage. [123] (10.1016/j.jhsg.2025.100864)
• [L5] The article reviews current evidence suggesting that thumb carpometacarpal joint osteoarthritis reflects the joint's teleology, where pathomechanics drive inflammatory markers and injury to soft tissue structures rather than simple wear and tear. [126] (10.1016/j.jhsa.2018.01.002)
• [L1] No surgical intervention was superior to the other for treating the first CMC joint osteoarthritis. [129] (10.1016/j.jhsg.2024.12.005)
• [Letter] Non-operative treatment for thumb base osteoarthritis has not been thoroughly explored and surgery may have a strong placebo effect, requiring further evaluation through pragmatic trials comparing surgery versus no surgery or placebo arms. [131] (10.1177/17531934211008365)
• [L3] The authors suggest that ulnar instability should be included in the classification of thumb CMCj osteoarthritis stages and considered in treatment options. [132] (10.1055/s-0039-1697650)
• [Paper] Without the need for an implant and because of its long-lasting benefits, total trapeziectomy is currently the only surgical technique for thumb basal joint arthritis that can lay claim to being a potential life-long procedure. [133] (10.1016/j.hansur.2020.05.015)
• [L5] Thumb CMC denervation is a treatment option for patients not responding to nonsurgical management, though its long-term durability is not yet established and it has not been included in systematic reviews comparing surgical options. [134] (10.1016/j.jhsa.2024.12.002)
• [L5] The authors advocate that routine retrieval and analysis of failed trapeziometacarpal joint implants be considered essential practice within hand surgery. [135] (10.1177/17531934261452468)
• [L5] The procedure results in a stable thumb with pain relief. [136] (10.1097/bth.0000000000000048)
• [L3] [138] (10.1177/1753193419873230)
• [L1] [139] (10.1177/1753193414563243)
• [L3] [140] (10.1016/j.jhsa.2011.06.017)
• [L4] [141] (10.1016/j.jhsa.2013.07.018)
• [L5] Prosthetic replacement is preferred in case of loosening when it is technically possible in order to preserve the thumb’s length. [143] (10.1016/j.hansur.2020.08.010)
• [L4] Trapezial-metacarpal joint replacement using an ARPE implant provides excellent pain relief, good function, and in the event of failure, uncomplicated potential for salvage. [144] (10.1016/j.jhsa.2013.08.073)
• [L3] This recommendation is made purely on the basis that this group had the lowest complication rates. [145] (10.1016/j.jhsb.2004.08.006)
• [L5] We present two case reports of successful total exchange arthroplasty at the carpometacarpal joint of the thumb using an ARPE implant. [147] (10.1016/j.main.2014.04.005)
• [L4] These rates are lower than those published previously and should be considered by patients and surgeons when planning thumb BJA. [148] (10.1016/j.jhsg.2019.10.003)
• [L3] The metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens. [149] (10.1055/s-0033-1350088)
• [L4] [150] (10.1097/00130911-200206000-00005)
• [L1] After interposition arthroplasty of the thumb followed by two weeks cast fixation, a thermoplastic short orthotic thumb device should be used. [151] (10.1186/s12891-025-08433-1)
• [L3] [154] (10.1177/1753193412466764)
• [L4] [155] (10.1177/15589447241231301)
• [Paper] [158] (10.1016/s0894-1130(04)00179-6)
• [L3] Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy. [161] (10.1177/1558944718765246)
• [L4] 30 hands (83.6%) had complete relief of pain. [164] (10.1016/s0266-7681(05)80140-8)
• [L5] Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of this procedure. [165] (10.1177/1753193416659230)
• [L4] The authors used continuous local anaesthetic infusion following trapeziectomy as a routine for 3 years on 40 patients. [166] (10.1016/j.jhsb.2006.04.022)
• [L4] This technique provides pain relief and satisfactory function at an average of 12.5 years after surgery. [167] (10.1016/j.jhsa.2016.04.018)
• [L4] [169] (10.1016/j.jhsa.2025.01.018)
• [L5] [170] (10.1097/bth.0b013e3181b4c388)
• [L4] Bone scan uptake after trapeziometacarpal joint arthroplasty progressively decreases over time, with normalization of tracer uptake expected between 14 and 25.5 months after surgery. [172] (10.1177/17531934251345359)
• [L4] [175] (10.1016/j.arthro.2010.07.006)
• [L4] Pain relief and improved hand function appear to be key determinants of patient satisfaction. [176] (10.1177/17531934261468204)
• [L4] [177] (10.1016/j.jhsa.2013.06.014)
• [L4] [178] (10.1016/j.hansur.2021.03.014)
• [L4] The procedure provided excellent pain control with a mean VAS score of 1.7 and allowed patients to return to occupational activities. [180] (10.4055/cios.2015.7.3.372)
• [L4] [182] (10.1016/j.jhsa.2014.11.026)
• [L4] The modified thumb CMC stress view radiograph evaluates laxity and joint abnormalities of the trapeziometacarpal articulation with high inter- and intra-observer reliability for radial subluxation and first metacarpal width. [184] (10.1016/j.jhsa.2009.06.030)
• [L4] Novel technologies such as 3D printed braces, image-guided injections, and advanced surgical techniques show promise in precision and patient satisfaction, but they are not yet established as superior to standard treatments of thumb CMC OA. [185] (10.5435/jaaos-d-23-01059)
• [L3] CMC arthroplasty has a very low overall complication rate of 1.3% and wound complication rate of 0.66%. [186] (10.1177/1558944717744341)
• [L5] Radiographic development of trapeziometacarpal arthrosis is an expected part of human aging, although clinically significant, functionally limiting trapeziometacarpal arthrosis is less common, and its development may be unrelated to hand use. [187] (10.1016/j.jhsa.2015.04.038)
• [L4] Advanced radiographic arthritis, current smoking status, and a history of ipsilateral hand surgery were patient-specific factors that predicted progression to surgery following injection. [188] (10.1016/j.jhsa.2020.03.025)
• [L4] A relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear. [190] (10.1177/1558944719886669)
• [L3] This study demonstrated that 1 in 6 thumbs underwent secondary TMC arthroplasty, an average of 11 months after the initial arthroscopy. [193] (10.1177/1558944717725382)
• [L4] Trapeziectomy with this alternative suspension technique for treatment of carpometacarpal thumb joint osteoarthritis shows good patient-reported outcome measures for primary surgery and poor patient-reported outcome measures after the secondary surgery. [194] (10.1016/j.jhsg.2022.02.006)
• [L3] Preoperative CMCJ steroid injection status does not affect major complication rates or functional outcomes following CMCJ arthroplasty. [196] (10.1177/15589447221081862)
• [L4] The results after revision surgery may be worse than previously described, and there may also be a tendency for worse results than those of primary arthroplasty. [197] (10.1177/15589447211028920)
• [L2] Patients who receive an intra-articular corticosteroid injection within the 3 months before surgery for CMC joint arthritis may be at increased risk of repeat surgery to treat a wound complication/infection in the 90-day postoperative period. [199] (10.1016/j.jhsa.2021.04.010)
• [L5] The study established consensus recommendations for six common revision scenarios using a rigorous Delphi process involving experienced hand surgeons worldwide. [200] (10.1177/17531934241227386)

See Also

• Trapeziectomy
• Arthroscopy
• Dislocations
• Joint Disease
• Basal Thumb Arthritis
• Reconstructive Surgery

References

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[9] Thumb CMCJ prosthetic total joint replacement: a systematic review. EFORT Open Reviews. 2021. DOI: 10.1302/2058-5241.6.200152

[10] Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Follow-Up of Long-Term Clinical Outcomes. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.02.005

[11] Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: 12- to 14-Year Follow-up. HAND. 2021. DOI: 10.1177/15589447211003176

[12] Provision of a Home-Based Video-Assisted Therapy Program Is Noninferior to In-Person Hand Therapy After Thumb Carpometacarpal Arthroplasty. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.23.00597

[14] The results of 479 thumb carpometacarpal joint replacements reported in the Norwegian Arthroplasty Register. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193413513988

[15] Risk Factors for Failed Nonsurgical Treatment Resulting in Surgery on Thumb Carpometacarpal Arthritis. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.02.009

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[17] Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis. Clinical Orthopaedics & Related Research. 2017. DOI: 10.1007/s11999-016-5151-2

[18] Basal thumb arthritis surgery: complications and its management. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934231197787

[19] Early Treatment of Degenerative Arthritis of the Thumb Carpometacarpal Joint. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2008.03.001

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