Skip to content

Clinicians › Hand

Thumb CMC arthroplasty

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

33 citationsUpdated Aug 2026

Overview

Trapeziometacarpal osteoarthritis is managed through a spectrum of surgical interventions, with ligament reconstruction and tendon interposition (LRTI) remaining the predominant option [3]. Nonprosthetic arthroplasty was the only cohort demonstrating increased utilization between 2010 and 2022 [3]. CMC arthroplasty implants are classified into four design types: total joint replacement, hemiarthroplasty, interposition arthroplasty, and miscellaneous designs [2]. Arthroscopic-assisted techniques are currently limited in use but may be a reasonable option for patients who do not respond to non-operative treatment [1].

Surgical selection is driven by patient activity and joint stability. CMC joint arthrodesis is indicated for younger, more manually active individuals or patients with extremely unstable thumb CMC joints, utilizing rigid fixation [4]. Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb, with no additional benefit shown from the addition of ligament reconstruction [7]. There is no significant benefit of LRTI over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis at 17-year follow-up [13]. Some authors favor ligament reconstruction over trapeziectomy alone to preserve arthroplasty space and prevent instability [16]. The postoperative position of the metacarpal base does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon interposition [6].

Comparative outcomes highlight distinct trade-offs between prosthetic and nonprosthetic approaches. At 1 year, total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire [10]. Total joint arthroplasty demonstrated a significant advantage in strength and range of motion compared to trapeziectomy at 1 year [10]. Trapeziometacarpal prosthesis shows promise for enhancing function, thumb length, and patient recovery in TMC arthrosis [12]. Outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from primary trapeziectomy results [8].

Current evidence landscape remains fragmented. Surgical preferences of US hand surgeons have not been influenced by past studies on the surgical treatment of trapeziometacarpal osteoarthritis [5]. Developing clinical practice guidelines for trapeziometacarpal osteoarthritis is considered premature due to a lack of reproducible high-quality evidence [5].

Anatomy & Pathophysiology

Osseous and Ligamentous Anatomy

Thumb metacarpal base fractures with associated subluxation or dislocation of the CMC joint account for nearly 80% of thumb CMC injuries [22], whereas isolated thumb CMC joint dislocations are rare [23]. In young, healthy patients, there are no sex differences in first CMC joint articular volume, curvature characteristics, or joint congruence after normalizing for joint size [28]; however, sex differences exist in the first CMC joint articular volume when not normalized for size [28]. The dorsoradial ligament (DRL) is the strongest and stiffest ligament of the trapeziometacarpal joint [38].

Arthroscopic Portal Anatomy and Safety

1R Portal: Located just radial to the abductor pollicis longus (APL) tendon, this portal passes through the nonligamentous capsule just lateral to the anterior oblique ligament (AOL) [32]. It is best for viewing the dorsoradial ligament (DRL), posterior oblique ligament (POL), and ulnar collateral ligament (UCL) [32].

1U Portal: Located just ulnar to the extensor pollicis brevis (EPB) tendon, this portal passes between or through the dorsoradial ligament (DRL) and posterior oblique ligament (POL) [32]. It provides good views of the anterior oblique ligament (AOL) and ulnar collateral ligament (UCL) [32].

Modified Radial Portal: Located just distal to the oblique ridge of the trapezium following a line along the radial border of the flexor carpi radialis (FCR) tendon [32]. This portal allows a better assessment of the dorsoradial ligament (DRL) and posterior oblique ligament (POL), and a complete view of the lateral side of the joint [32].

Thenar Portal: Created through the bulk of the thenar muscles at the level of the thumb CMC joint, approximately 90 degrees from the 1U portal [32]. It allows visualization of the ulnar recess and complements the ulnar tubercle [32].

Distal Dorsal (D2) Accessory Portal: Situated in the dorsal aspect of the first web space ulnar to the extensor pollicis longus (EPL) tendon and 1 cm distal to the V-shaped soft spot at the junction of the index and thumb metacarpal bases [32]. This portal lies just distal to the dorsal intermetacarpal ligament (DIML) [32].

Vascular and Neural Considerations

There is no true internervous plane for the 1R and 1U portals because branches of the superficial radial nerve (SRN) surround the posterior aspect and are at risk for injury [32]. The radial artery courses immediately posterior and ulnar to the arthroscopic field of the thumb CMC joint [32]. The terminal branches of the motor branch of the ulnar nerve (MBMN) are located in the proximal third of the thenar muscles, posing a risk to the thenar portal [32]. There is no true safe zone for the D2 portal due to the nearby dorsal branch of the radial artery [32].

Classification

Surgical Modality: Ligament reconstruction and tendon interposition (LRTI) remains the predominant surgical option for thumb CMC arthritis [3]. Nonprosthetic arthroplasty is the only cohort of surgical interventions for thumb CMC arthritis that has shown an increasing utilization trend from 2010 to 2022 [3]. Arthroscopic-assisted techniques are considered a reasonable option for patients who do not respond to non-operative treatment [1].

Procedure Comparison: Simple trapeziectomy is an effective operation for thumb base osteoarthrosis, with no additional benefit shown from the addition of ligament reconstruction [7]. There is no significant benefit of LRTI over trapeziectomy alone for thumb CMC joint osteoarthritis at 17-year follow-up [13]. Active key pinch is stronger with CMC arthrodesis compared to reconstruction, but the reconstruction allows for a wider grasp of large objects [9]. Arthrodesis displays better pinch strength, while arthroplasty displays better motor function in the treatment of thumb carpometacarpal osteoarthritis [19].

Implant/Technique Specifics: At 1 year, total joint arthroplasty showed no superiority over trapeziectomy regarding total Michigan Hand Outcomes Questionnaire scores, but demonstrated significant advantages in strength and range of motion [10]. Pyrolytic carbon hemiarthroplasty (PH) provides superior postoperative pinch strength and subtle improvements in subjective outcomes compared to Thompson suspensionplasty (TS) [17]. Thompson suspensionplasty (TS) provides a lower risk of complications, reoperation, or joint revision surgery compared to pyrolytic carbon hemiarthroplasty (PH) [17].

Other Considerations: Surgical preferences for trapeziometacarpal osteoarthritis have not been influenced by past studies, and clinical practice guidelines are considered premature due to a lack of reproducible high-quality evidence [5]. Wrist radiographs have 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid (ST) joint arthritis, highlighting the importance of direct ST joint visualization after trapeziectomy [11]. Custom thumb CMC orthotics demonstrate a greater clinical effect than prefabricated orthotics for improving function and reducing pain, particularly in the dominant hand [15].

Clinical Presentation

Diagnostic evaluation of thumb carpometacarpal (CMC) osteoarthritis requires careful patient selection, as desired outcomes for successful basilar arthroplasty vary by age and activity levels [37]. The presence of arthritis in adjacent joints, such as the scaphotrapezoid (ST) joint, complicates this selection process [37]. Radiographic assessment is critical; wrist radiographs demonstrate 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis [11]. Anatomical variations may influence prevalence, with a higher mean dorsovolar curvature of the metacarpal and trapezial surfaces in European samples potentially explaining the higher frequency of TM osteoarthritis in this population [20].

Physical examination relies on standardized provocative maneuvers to reproduce symptoms. The authors propose adopting the terms 'ulnar shift test' and 'volar shift test' to standardize nomenclature, noting that reducing the metacarpal in a radial-dorsal to volar-ulnar direction is more reliable for reproducing symptoms than the grind test [24].

Non-operative management remains a primary consideration. The custom thumb CMC orthotic demonstrates a greater clinical effect than the prefabricated orthotic for improving function and reducing pain, particularly in the dominant hand, though both provide positive effects on function, pain, and strength [15]. Developing clinical practice guidelines to steer decision-making for trapeziometacarpal osteoarthritis is premature given the lack of reproducible high-quality evidence [5].

Surgical intervention is indicated when non-operative measures fail. Arthroscopic-assisted techniques for thumb CMC OA are a reasonable option for patients who do not respond to non-operative treatment [1]. For younger, more manually active individuals or patients with extremely unstable thumb CMC joints, CMC joint arthrodesis should be performed using rigid fixation [4]. Autogenous bone grafting may contribute to bone union in the arthrodesis of thumb carpometacarpal arthritis [21].

Trapeziectomy is a good method of treating osteoarthritis of the thumb base [18]. Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb, and the addition of a ligament reconstruction was not shown to confer any additional benefit [7]. This lack of benefit persists even at 17 years, with no significant benefit of ligament reconstruction and tendon interposition (LRTI) over trapeziectomy alone [13]. The postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with LRTI [6]. Furthermore, outcomes for the anterior approach are equally good or better than with the posterior approach [18].

Total joint arthroplasty and trapeziectomy offer distinct functional profiles. At 1 year, total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire, but demonstrated a significant advantage in strength and range of motion [10]. At 5 years, total joint arthroplasty did not show superior patient-reported outcomes on the Michigan Hand Outcomes Questionnaire compared with trapeziectomy [29]. Active key pinch is stronger with CMC arthrodesis, but the reconstruction does not open as far when grasping large objects [9]. Trapeziometacarpal prosthesis shows promise for TMC arthrosis, enhancing function, thumb length, and patient recovery [12].

Secondary procedures yield comparable results to primary interventions. The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from primary trapeziectomy results [8].

Investigations

Plain radiography: Wrist radiographs demonstrate 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis [11]. Due to these limitations in radiographic prediction, direct visualization of the scaphotrapezoid joint is important after trapeziectomy [11]. Imaging of the contralateral thumb is helpful due to wide variation in CMC anatomy and radiographic appearance [23].

Other Considerations: Developing clinical practice guidelines for trapeziometacarpal osteoarthritis is premature due to a lack of reproducible high-quality evidence [5]. There are sex differences in first CMC joint articular volume without normalizing for size [28]. A tendency toward higher mean dorsovolar curvature of the metacarpal and trapezial surface in European populations may explain the higher frequency of thumb base osteoarthritis in this group [20]. Larger prospectively designed studies of high-quality evidence are necessary to delineate differences between ligament reconstruction with tendon interposition and suture-button suspensionplasty [30].

Treatment

Non-Operative

Custom and prefabricated CMC stabilizing splints provide positive effects on function, pain, and strength [15]. Use of these splints improves hand function and reduces hand pain after four weeks without interfering with pinch strength [26]. Regarding specific device selection, the Hybrid splint provides modest but significantly greater pain relief compared to the Comfort Cool splint after four weeks of use [41].

Operative

Indications: Surgery is indicated for patients with advanced thumb CMC osteoarthritis who have significant pain and persistent functional limitations, particularly when non-operative treatments fail [1, 40]. Arthroscopic-assisted techniques remain a reasonable option for this population, although their use is still limited [1].

Surgical Approach / Technique: Trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb [7]. The anterior surgical approach yields outcomes that are equally good or better than the posterior approach [18]. For arthrodesis, autogenous bone grafting may contribute to bone union [21]. In trapeziectomy with ligament reconstruction and tendon interposition (LRTI), the postoperative position of the metacarpal base does not affect clinical or subjective outcomes [6].

Implant Selection: Simple trapeziectomy is an effective operation [7]. Even at 17 years, there is no significant benefit of LRTI over trapeziectomy alone for thumb CMC joint osteoarthritis [13]. The addition of ligament reconstruction to simple trapeziectomy was not shown to confer any additional benefit [7]. However, some authors favor ligament reconstruction over trapeziectomy alone to preserve arthroplasty space and prevent instability, though they acknowledge the need for long-term randomized studies to confirm the benefits of simple trapeziectomy [16].

Total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire at 1 year, but demonstrated a significant advantage in strength and range of motion [10]. Surgeons should consider total arthroplasty as a first-line therapeutic option for patients with advanced TMC arthritis, as it provides superior pain relief and greater improvement in functional disability compared to trapeziectomy with ligamentoplasty [40].

For hemiarthroplasty, pyrolytic carbon hemiarthroplasty (PH) provided superior postoperative pinch strength and subtle improvements in subjective outcome as evidenced by Nelson scores compared to Thompson suspensionplasty (TS) [17]. Thompson suspensionplasty provided a lower risk of complications, reoperation, or joint revision surgery compared to PH [17]. The decision to perform prosthetic arthroplasty with PH versus soft-tissue suspension with TS should be made with patient goals in mind and in light of the higher risk of complications associated with prosthetic arthroplasty [17].

Functional Outcomes Comparison: Arthrodesis displays better pinch strength compared to arthroplasty in Chinese patients with thumb CMC osteoarthritis [19]. Conversely, arthroplasty displays better motor function compared to arthrodesis in this same population [19].

Other Considerations: Of surgical options to address thumb CMC arthritis, LRTI still predominates, but nonprosthetic arthroplasty was the only cohort increasing in utilization from 2010 to 2022 [3]. Surgical preferences of US hand surgeons have not been influenced or changed by past studies of the surgical treatment of TMC osteoarthritis [5]. Developing clinical practice guidelines to steer decision making for TMC osteoarthritis is premature given the lack of reproducible high-quality evidence [5].

Complications

Infection (PJI): The provided evidence does not contain specific data regarding infection rates or management for thumb CMC arthroplasty.

Aseptic loosening: Revision surgery rates due to persistent pain and instability were higher with the use of implants in thumb CMC joint hemiresection interposition arthroplasty [42].

Instability: Some authors favor ligament reconstruction over trapeziectomy alone to preserve arthroplasty space and prevent instability, though long-term randomized studies are needed to confirm the benefits of simple trapeziectomy [16]. Active key pinch is stronger with CMC arthrodesis, but the reconstruction does not open as far when grasping large objects in tetraplegic patients [9]. CMC joint arthrodesis is indicated only for younger, more manually active individuals or patients with extremely unstable thumb CMC joints, requiring rigid fixation [4].

Periprosthetic fracture: The provided evidence does not contain specific data regarding periprosthetic fractures for thumb CMC arthroplasty.

Thromboembolism: The provided evidence does not contain specific data regarding thromboembolism for thumb CMC arthroplasty.

Patellar / Extensor-mechanism: The provided evidence does not contain specific data regarding extensor-mechanism complications for thumb CMC arthroplasty.

Stiffness / Arthrofibrosis: At 1 year, total joint arthroplasty demonstrated no superiority over trapeziectomy regarding total Michigan Hand Outcomes Questionnaire scores, but showed significant advantages in strength and range of motion [10].

Nerve palsy: The provided evidence does not contain specific data regarding nerve palsies for thumb CMC arthroplasty.

Wound complications: The provided evidence does not contain specific data regarding wound complications for thumb CMC arthroplasty.

Polyethylene wear: The provided evidence does not contain specific data regarding polyethylene wear for thumb CMC arthroplasty.

Other Considerations: Arthroscopic-assisted techniques for thumb CMC OA are associated with limited use, though they may be a reasonable option for patients who do not respond to non-operative treatment [1]. Nonprosthetic arthroplasty was the only surgical cohort for thumb CMC arthritis showing an increase in utilization from 2010 to 2022 [3]. Developing clinical practice guidelines for the surgical treatment of trapeziometacarpal osteoarthritis is premature due to a lack of reproducible high-quality evidence [5]. Wrist radiographs demonstrate 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy [11]. At 17 years, there is no significant benefit of ligament reconstruction with tendon interposition (LRTI) over trapeziectomy alone for thumb CMC joint osteoarthritis [13]. Pyrolytic carbon hemiarthroplasty (PH) provided superior postoperative pinch strength and subtle improvements in subjective outcome compared to Thompson suspensionplasty (TS) [17]. The decision to perform prosthetic arthroplasty with PH versus soft-tissue suspension with TS should be made with patient goals in mind due to the higher risk of complications associated with prosthetic arthroplasty [17]. At 5 years, total joint arthroplasty did not show superior patient-reported outcomes on the MHOQ compared with trapeziectomy [29]. Larger prospectively designed studies of high-quality evidence are necessary to delineate whether a difference exists between ligament reconstruction with tendon interposition and suture-button suspensionplasty [30].

Recovery

Light activity (weeks): Arthroscopic-assisted techniques for thumb CMC OA may be a reasonable option for patients who do not respond to non-operative treatment [1].

Full activity (months): Trapeziometacarpal prosthesis enhances function, thumb length, and patient recovery [12].

Complete recovery / outcome plateau (months): Total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire at 1 year [10].

Rehabilitation protocol: Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb, and the addition of ligament reconstruction was not shown to confer any additional benefit [7].

Functional milestones: Pyrolytic carbon hemiarthroplasty (PH) provided superior postoperative pinch strength compared to Thompson suspensionplasty (TS) [17]. Pyrolytic carbon hemiarthroplasty (PH) provided subtle improvements in subjective outcome as evidenced by Nelson scores compared to Thompson suspensionplasty (TS) [17].

Other Considerations: Nonprosthetic arthroplasty was the only surgical cohort for thumb carpometacarpal arthritis increasing in utilization from 2010 to 2022 [3].

Key Evidence

  • [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. [1] (10.1177/1753193418757122)
  • [L4] This systematic review classifies CMC arthroplasty implants into four design types: total joint replacement, hemiarthroplasty, interposition arthroplasty, and miscellaneous designs, providing an overview of strategies, design changes, and biomechanical characteristics of currently available implants for treating osteoarthritis of the thumb. [2] (10.1016/j.jhsa.2019.11.015)
  • [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. [3] (10.1016/j.jhsa.2025.03.014)
  • [Commentary] CMC joint arthrodesis should be performed only in younger, more manually active individuals or patients with extremely unstable thumb CMC joints, using rigid fixation. [4] (10.1177/1753193414563654)
  • [L5] Surgical preferences of US hand surgeons have not been influenced or changed by past studies of the surgical treatment of trapeziometacarpal osteoarthritis, and developing clinical practice guidelines to steer decision making is premature given the lack of reproducible high-quality evidence. [5] (10.1016/j.jhsa.2012.02.040)
  • [L3] Postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon interposition of the thumb carpometacarpal joint. [6] (10.1177/1753193415616959)
  • [L1] Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb and the addition of a ligament reconstruction was not shown to confer any additional benefit. [7] (10.1054/jhsb.2000.0431)
  • [L3] The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results. [8] (10.1016/j.jhsa.2013.01.030)
  • [L4] Active key pinch is stronger with CMC arthrodesis, but the reconstruction does not open as far when grasping large objects. [9] (10.1016/j.jhsa.2017.10.029)
  • [L1] At 1 year, total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire, but demonstrated a significant advantage in strength and range of motion. [10] (10.1177/17531934231185245)
  • [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. [11] (10.1177/1558944718765246)
  • [L3] Trapeziometacarpal prosthesis shows promise for TMC arthrosis, enhancing function, thumb length, and patient recovery, warranting further research and x-ray guidance. [12] (10.1016/j.jhsg.2024.03.004)
  • [L1] Even at 17 years there is no significant benefit of LRTI over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis. [13] (10.1177/1753193420952966)
  • [L5] The custom thumb CMC orthotic demonstrates a greater clinical effect than the prefabricated orthotic for improving function and reducing pain, particularly in the dominant hand, though both provide positive effects on function, pain, and strength. [15] (10.1016/j.jht.2011.04.002)
  • [L5] The authors favor ligament reconstruction over trapeziectomy alone to preserve arthroplasty space and prevent instability, though they acknowledge the need for long-term randomized studies to confirm the benefits of simple trapeziectomy. [16] (10.2106/00004623-200411000-00040)
  • [L3] [17] (10.1016/j.jhsa.2014.06.058)
  • [L1] Trapeziectomy is a good method of treating osteoarthritis of the thumb base, but outcomes for the anterior approach are equally good or better than with the posterior approach. [18] (10.1177/1753193407087571)
  • [L3] Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function. [19] (10.1186/s13018-019-1469-2)
  • [L4] A tendency toward higher mean dorsovolar curvature of both the metacarpal and trapezial surface in the European sample may help to explain the higher frequency of TM osteoarthritis reported in Europeans. [20] (10.1016/j.jhsa.2011.09.007)
  • [L3] Autogenous bone grafting may contribute to the bone union in the arthrodesis of thumb carpometacarpal arthritis. [21] (10.1177/17531934221138917)
  • [L5] The authors propose adopting the terms 'ulnar shift test' and 'volar shift test' to standardize nomenclature for provocative tests, noting that reducing the metacarpal in a radial-dorsal to volar-ulnar direction is more reliable for reproducing symptoms than the grind test. [24] (10.1177/1753193419896247)
  • [L2] After four weeks, CMC stabilizing splints improve hand function, reduce hand pain, and do not interfere with pinch strength. [26] (10.1016/j.jht.2009.07.014)
  • [L4] This study found that there are sex differences in the first CMC joint articular volume without normalizing for size; however, there are no sex differences in first CMC joint articular volume, curvature characteristics, or joint congruence of young, healthy patients after normalizing for joint size. [28] (10.1177/1558944716688528)
  • [L1] At 5-years, total joint arthroplasty did not show superior patient-reported outcomes on the MHOQ compared with trapeziectomy. [29] (10.1177/17531934251357456)
  • [L2] Larger prospectively designed studies of high-quality evidence are necessary to truly delineate whether a difference exists between these 2 techniques. [30] (10.1177/15589447211043217)
  • [Paper] [37] (10.1097/corr.0000000000003452)
  • [L5] The study confirms that the dorsoradial ligament (DRL) is the strongest and stiffest ligament of the trapeziometacarpal joint, suggesting it should be repaired or reconstructed when disrupted to restore joint stability. [38] (10.1016/j.jhsa.2014.02.025)
  • [L2] Surgeons should consider total arthroplasty as a first-line therapeutic option for patients with advanced TMC arthritis, especially those with significant pain and persistent functional limitations, as it provides superior pain relief and greater improvement in functional disability compared to trapeziectomy with ligamentoplasty. [40] (10.1097/corr.0000000000003404)
  • [L2] After four weeks of splint use, individuals with CMC OA had modest but significantly greater pain relief from the Hybrid splint than the Comfort Cool, which was the only significant difference between the two splints. [41] (10.1016/s0363-5023(09)60144-1)
  • [L2] Revision surgery rates due to persistent pain and instability were higher with the use of implants. [42] (10.1177/1558944720974124)

See Also

References

[1] A systematic review and meta-analysis of arthroscopic assisted techniques for thumb carpometacarpal joint osteoarthritis. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418757122

[2] Trends in Trapeziometacarpal Implant Design: A Systematic Survey Based on Patents and Administrative Databases. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.11.015

[3] National Trends of Surgical Interventions for Thumb Carpometacarpal Arthritis From 2010 to 2022. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.03.014

[4] Commentary on Singh et al. Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation and Smeraglia et al. Trapeziometacarpal arthrodesis: is bone union necessary for a good outcome?. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193414563654

[5] Re: “Current Trends in Nonoperative and Operative Treatment of Trapeziometacarpal Osteoarthritis: A Survey of US Hand Surgeons”. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.040

[6] Comparison of clinical outcome with radiological findings after trapeziectomy with ligament reconstruction and tendon interposition. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415616959

[7] A Comparison of Trapeziectomy with and without Ligament Reconstruction and Tendon Interposition. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0431

[8] Outcome Comparison of Primary Trapeziectomy Versus Secondary Trapeziectomy Following Failed Total Trapeziometacarpal Joint Replacement. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.01.030

[9] Arthrodesis Versus Carpometacarpal Preservation in Key-Grip Procedures in Tetraplegic Patients: A Comparative Study of 40 Cases. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.10.029

[10] Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231185245

[11] Comparison of Radiographic and Intraoperative Visual Assessment of Scaphotrapezoid Joint Arthritis in Patients With End-Stage Carpometacarpal Arthritis of the Thumb Base. HAND. 2018. DOI: 10.1177/1558944718765246

[12] Comparative Analysis of Prosthetic (Touch) and Arthroplastic Surgeries for Trapeziometacarpal Arthrosis: Functional Outcomes and Patient Satisfaction With a 2-Year Follow-Up. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.03.004

[13] Simple trapeziectomy versus trapeziectomy with flexor carpi radialis suspension: a 17-year follow-up of a randomized blind trial. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420952966

[15] Clinical Commentary in Response to: Comparison of Two Carpometacarpal Stabilizing Splints for Individuals with Thumb Osteoarthritis. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2011.04.002

[16] Ligament Reconstruction Versus Trapezial Resection Alone for Thumb Carpometacarpal Osteoarthritis. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200411000-00040

[17] Comparison of Thompson Suspensionplasty Versus Pyrolytic Carbon Implant Hemiarthroplasty in the Treatment of Trapeziometacarpal Arthritis of the Thumb. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.058

[18] A Comparison of Trapeziectomy Via Anterior and Posterior Approaches. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193407087571

[19] Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1469-2

[20] Three-Dimensional Quantitative Comparative Analysis of Trapezial-Metacarpal Joint Surface Curvatures in Human Populations. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.09.007

[21] Comparative study on the effectiveness of bone grafting for arthrodesis of the thumb carpometacarpal arthritis. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221138917

[22] Rockwood And Green S Fractures In Adults. 42: Fractures of the Distal Radius and Ulna > Thumb CMC Joint Dislocation with Fracture.

[23] Rockwood And Green S Fractures In Adults. 42: Fractures of the Distal Radius and Ulna > Thumb CMC Joint Dislocation without Fracture.

[24] Re: Mailey et al. Comparison of provocative manoeuvres in diagnosing thumb carpometacarpal joint arthritis. J Hand Surg Eur. 2019, 44: 750–2.. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193419896247

[26] Comparison of Two Carpometacarpal Stabilizing Splints for Individuals with Thumb Osteoarthritis. Journal of Hand Therapy. 2009. DOI: 10.1016/j.jht.2009.07.014

[28] Comparison of Computed Tomography Articular Surface Geometry of Male Versus Female Thumb Carpometacarpal Joints. HAND. 2017. DOI: 10.1177/1558944716688528

[29] Total joint arthroplasty versus trapeziectomy for trapeziometacarpal joint arthritis: 5-year follow-up of a randomized controlled trial. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251357456

[30] Systematic Comparison of Ligament Reconstruction With Tendon Interposition and Suture-Button Suspensionplasty for Trapeziometacarpal Osteoarthritis. HAND. 2022. DOI: 10.1177/15589447211043217

[32] Green S Operative Hand Surgery. AUTHOR'S PREFERRED METHOD OF TREATMENT: ARTHROSCOPIC PARTIAL WRIST FUSION > Thumb CMC Joint Arthroscopic Portals.

[37] CORR Insights®: Total Arthroplasty Versus Trapeziectomy With Ligamentoplasty for Trapeziometacarpal Osteoarthritis: 5-year Outcomes. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003452

[38] Comparison of the Anatomical Dimensions and Mechanical Properties of the Dorsoradial and Anterior Oblique Ligaments of the Trapeziometacarpal Joint. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.025

[40] Total Arthroplasty Versus Trapeziectomy With Ligamentoplasty for Trapeziometacarpal Osteoarthritis: 5-year Outcomes. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003404

[41] Comparison of Two Carpometacarpal Stabilizing Splints for Individuals with Thumb Osteoarthritis. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60144-1

[42] Systematic Review of Thumb Carpometacarpal Joint Hemiresection Interposition Arthroplasty Materials. HAND. 2020. DOI: 10.1177/1558944720974124

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.