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Touch thumb arthroplasty

Surgeon-side topic for touch thumb arthroplasty. Backed by 349 articles from the corpus, retrieved via combined MeSH + title-text matching.

140 citationsUpdated Oct 2026

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Overview

Thumb arthroplasty serves as a reliable long-term solution for thumb base arthritis, delivering significant pain reduction and functional improvement that persists even after 15 years of follow-up [3]. Total joint arthroplasty of the carpometacarpal joint is efficacious, improving motion, strength, and pain relief [4], while ligament reconstruction and tendon interposition (LRTI) yields very good patient satisfaction and high objective functional measures, including restored strength and dexterity in severely affected thumbs [1]. Total joint replacement offers distinct advantages over other surgical treatments, including restoration of thumb length and alignment, good cosmetic results, and faster recovery [21]. However, the procedure is technically demanding with a potentially higher complication rate [21]. For the TouchRV prosthesis specifically, a 96% implant survival rate at 2 years has been reported with promising patient-reported and clinical outcomes [24], leading authors to recommend it as standard treatment for isolated trapeziometacarpal joint osteoarthritis [24]. Biomechanically, total joint arthroplasty with a Touch prosthesis may yield a superior profile where tendon loads required for key pinch force are lower and better distributed between actuator muscles compared with trapeziectomy with or without ligament reconstruction [18].

Current surgical preferences among US hand surgeons have not changed substantially in response to outcome studies [87], with LRTI still predominating, though nonprosthetic arthroplasty is the only cohort increasing in utilization [64]. Total trapeziectomy remains the only surgical technique for thumb basal joint arthritis that can claim to be a potential life-long procedure due to its lack of implant dependency and long-lasting benefits [61]. While 1-year postoperative outcomes are similar for tendon arthroplasty and total joint replacement, the complexity of thumb arthritis necessitates further investigation into comparative efficacy, long-term outcomes, and potential complications [15]. Long-term data are necessary to establish the place of Artelon interposition arthroplasty [10], and although thumb abduction reduces from 3.5 to 13 years post-surgery, other functional gains are retained or slightly improved [9].

Complications after surgery for basal thumb arthritis are common, with high rates of deformity recurrence depending on implant type and joint involved [5, 6]. Routine retrieval and analysis of failed implants is advocated as essential practice within hand surgery [22]. In cases of loosening, prosthetic replacement is preferred when technically possible to preserve thumb length [25]. Revision surgery outcomes are less favourable than primary LRTI, with only 68% of patients indicating their thumb was better than before primary surgery [37]. Nevertheless, Swanson silastic interposition arthroplasty provides good medium-term results and high satisfaction in revision settings, provided other treatable causes of poor outcome are excluded [23]. Standardized data sets are lacking in major hand journals, and functional scores are used infrequently in implant arthroplasty studies despite their importance [11]. Patients treated with hand therapy had significantly longer times to surgery, and 2-year surgery rates were significantly higher in those who did not undergo therapy [13].

Anatomy & Pathophysiology

Bony Anatomy & Joint Structure

The trapeziometacarpal (TMC) joint features reciprocal concave surfaces on the base of the thumb metacarpal and the distal articular surface of the trapezium, affording exceptional mobility with minimum osseous constraint [28]. Contact stresses within this joint are large [28]. The radius of curvature of the thumb metacarpal articular surface is approximately one-third larger than the trapezial surface [52]. Little bony constraint exists at the TMC joint except at the extremes of motion [52]. The trapezium is angled out in front of the carpal plane so that the first metacarpal makes an angle of about 45 degrees with the second metacarpal in the sagittal plane [42]. The thumb metacarpal is the shortest metacarpal [42]. The basal joint complex of the thumb comprises four articulations of the trapezium, including the thumb metacarpal, scaphoid, and trapezoid, and the radial facet of the index metacarpal [69]. The trapeziometacarpal articulation evolved from a single-axis hinge in simian ancestors to a functional universal joint in humans [69]. Recession of the prominent volar metacarpal beak facilitated rotational movement of the thumb ray [69].

Ligaments & Soft Tissue Stability

The primary contact area during functional activities involving flexion and adduction of the thumb involves the palmar surfaces of the trapezium and the metacarpal [28]. Postmortem material provides evidence of a palmar pattern of wear of the joint surface in close association with degeneration of the palmar oblique ligament from the articular margin of the metacarpal [28]. The palmar oblique ligament is referred to as the "beak ligament" because of its origin from the volar ulnar beak of the base of the metacarpal [28]. A mechanism for osteoarthritis of the basal joint is predicated on incompetence of the beak ligament [28]. Symptomatic relief and prevention of osteoarthritis follow ligament reconstruction in thumbs with abnormal trapeziometacarpal laxity [28]. The residual "beak ligament" assumes the task of stabilizing the metacarpal in lateral pinch [69]. Thumb basal joint ligamentous anatomy provides extraordinary stability without sacrificing motion [199]. During pinch and grip, cantilever bending forces are resisted and large loads are accommodated without subluxation or pain when ligamentous restraint is intact [199].

Pathomechanics & Disease Progression

When ligamentous restraint is compromised, functional grip and pinch can result in painful synovitis and hypermobility at the trapeziometacarpal joint long before the development of cartilage wear and arthritis [199]. Painful basal joint hypermobility develops because of pathologic translation of TM joint surfaces during lateral pinch [52]. A past history of a benign "sprain" may reflect transient TM subluxation with secondary injury to the palmar oblique (beak ligament) [52]. Forces experienced at the thumb tip during lateral pinch are multiplied several-fold at the TM joint [52]. Painful instability predicated upon translational laxity of the TM joint surfaces is the hallmark of clinically apparent disease at the base of the thumb [69]. Advanced disease limits breadth of grasp and forceful lateral pinch activities such as brushing teeth, sewing or needlepoint, turning a key, opening a car door, or picking up a book [69]. Complaints are vaguely directed to the base of the thumb and pain is frequently associated with a sensation of movement or "slipping" within the joint [69].

Disease Staging: * Stage I: Involves synovitis of the carpometacarpal joint and pathological laxity without eburnation of the cartilage and narrowing of the joint space [28]. * Stages II and III: Characterized by attrition of the beak ligament, loss of cartilage, narrowing of the joint space, and formation of osteophytes and loose bodies that are less than and greater than two millimeters in diameter, respectively [28]. * Stage IV: Represents the end stage — that is, pantrapezial osteoarthritis [28].

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 [142]. Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis [125]. Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes [113].

Kinematics & Biomechanics

Total joint arthroplasty is able to restore thumb function but cannot fully replicate the kinematics of the healthy TMC joint [12]. Proximal migration of the thumb metacarpal does not appear to influence the functional outcome [17]. Three-dimensional assessment of thumb kinematics can enhance understanding of expected outcomes and aid in postoperative assessment and patient education [26]. During thumb oppositional motion, internal rotation of the first metacarpal occurred, with the palmar base rotating primarily with respect to the dorsal base [120]. 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 [119]. Thumb motion capability was unaffected by sex and handedness [112]. Directionally coupled motion patterns in the CMC joint are similar in men and women [131]. 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 [116].

Wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model [109]. Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage OA [111]. The automated approach using four-dimensional computed tomography significantly decreased the time needed to analyse each case and makes this model applicable for further research on TMC kinematics [127]. The dominant postoperative effect of first metacarpal extension osteotomy was palmar loading with reduced dynamic variability [133]. 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 [132]. This biomechanical cadaver study supports the hypothesis that trapeziectomy results in proximal migration of the first metacarpal, which is mitigated by suture suspensionplasty while maintaining normal motion [124]. The suspension imparts an ulnarly directed force to the base of the first metacarpal that prevents adduction collapse of the thumb [51]. Dorsal inclination of the cup should be avoided as it increases the risk of dislocation during thumb flexion and opposition [141]. These data may be useful for helping the understanding of the biomechanics of the basal joint of the thumb [102]. This study contributes to a further understanding of the biomechanics of the intact and surgically repaired TMC joint and addresses the biomechanical consequences of changing a joint’s DoF by surgery [130].

Epidemiology & Clinical Presentation

The prevalence of primary osteoarthritis in the TMC joint is reported to be as high as 15% in adults over age 30 [82]. As many as one-third of postmenopausal women are affected by primary osteoarthritis of the TMC joint [82]. The thumb provides approximately 40% of hand function and nearly one-fourth of overall bodily function [82]. The insidious development of symptoms in the young female may be associated with generalized ligamentous laxity [52]. Ergonomic solutions are necessary to decrease thumb motions or strenuous effort encountered at work, especially for women [128]. The cause of arthritic pain remains uncertain, as is the natural history [59]. There is some evidence that many patients with advanced TBOA, traditionally eligible for an operation, do well without surgery [59]. Surgery is known to have unexplained benefits that can be ascribed to a 'placebo effect' [59].

Classification

Eaton–Littler: The Eaton–Littler radiographic classification system is used to stage thumb trapeziometacarpal joint osteoarthritis preoperatively [57]. In trapeziometacarpal joint implant arthroplasty studies, the severity of baseline osteoarthritis is graded from stage I to stage IV using the Eaton classification [164].

Anatomical Radiological Classification: An anatomically based radiological classification has been proposed to differentiate between the different forms of thumb basal joint arthritis to allow prospective studies to assess results [162].

Other Considerations: The radiological classification of trapeziometacarpal joint osteoarthritis does not describe all stages accurately enough to permit reliable and consistent communication between clinicians [89]. A review of radiological imaging for the trapeziometacarpal joint describes various measurements and classifications used to evaluate the joint [27]. The metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens [34]. The Delphi consensus on diagnostic and treatment recommendations for recurrent or persistent symptoms after trapeziectomy established recommendations for six common revision scenarios [88].

Clinical Presentation

Symptoms and Functional Impairment

Pain localizes to the base of the thumb but may radiate proximally to the radial forearm [54]. The hallmark of clinically apparent disease is painful instability predicated upon translational laxity of the trapeziometacarpal joint surfaces [69]. Thumb CMC arthritis is a potentially debilitating condition causing pain and weakness with the essential movements of the first metacarpal-trapezial joint: opposition, key pinch (prehension), and circumduction [54]. The greatest functional impairment occurs with advanced disease limiting breadth of grasp and forceful lateral pinch activities such as brushing teeth, sewing or needlepoint, turning a key, opening a car door, or picking up a book [69]. Patients with TMC OA predominantly visit hand surgeons seeking treatment to reduce pain, whereas function and aesthetics have minor roles [158].

Physical Examination Findings

The synovitis and effusion of early disease may be associated with thenar tenderness and first webspace cramping [54]. 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 [54]. There is a poor correlation between radiographic severity of degenerative disease and clinical symptomatology [72]. The high prevalence of other symptomatic disorders of the hand requires a complete and standardized clinical examination of the hand, as they must be considered during surgical planning [150].

Epidemiology and Risk Factors

Thumb CMC arthritis is the second most common location for osteoarthritis in the upper limb after the distal interphalangeal joints [54]. Postmenopausal women are the most common thumb CMC arthritis patients, with 40% to 57% exhibiting radiographic evidence of disease [54]. Middle-aged women have significant joint involvement at 10% [54]. Men over 75 years of age have significant joint involvement at 25% [54]. 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 [35].

Investigations

Clinical Assessment: A careful physical examination is essential to direct care and future testing, as diagnostic tests such as imaging and serum laboratory studies can be expensive, time-consuming, and often nonspecific [40]. There is a poor correlation between the radiographic severity of degenerative disease at the thumb trapeziometacarpal joint and clinical symptomatology [72]. Radiographic development of trapeziometacarpal arthrosis is an expected part of human aging, although clinically significant, functionally limiting trapeziometacarpal arthrosis is less common [207].

Plain radiography: Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis [173]. The radiological classification of osteoarthritis at the trapeziometacarpal joint does not describe all stages of carpometacarpal joint osteoarthritis accurately enough to permit reliable and consistent communication between clinicians [89]. Dual-plane radiographs are used preoperatively to assess inclusion criteria and deformities, and postoperatively to determine the length of the first (M1) and second metacarpal (M2) bones [29]. The M1/M2 ratio is calculated preoperatively and postoperatively using dual-plane radiographs to assess thumb column length [29].

Post-arthroplasty Radiographic Findings: In cementless trapeziometacarpal arthroplasty, only 23% of stems had cortical contact on postoperative radiographs [39]. Radiographic analysis showed a constant lengthening of the thumb column after prosthetic trapeziometacarpal arthroplasty and a shortening after trapeziectomy-ligamentoplasty [204]. Radiographic assessment of trapeziometacarpal instability surgery showed only one scaphoid cup loosening and a shortening of 0.2 cm in the length of the thumb column after surgery [66]. Adverse radiographic findings were nearly universal in patients undergoing spherical ceramic trapezial-metacarpal arthroplasty, despite most patients being satisfied with function and pain relief [50]. Trapeziometacarpal arthroplasty serves as a spacer that avoids collapse of the thumb base even after radiographic failure [212]. Bone union for V-shaped osteotomy thumb basal joint arthrodesis was confirmed radiographically after a mean of 6 weeks [71].

Bone scan: Bone scintigraphy using Tc-99m–labeled diphosphonates measures increased bone formation, which can be a sign of problematic bone fixation and is useful in the diagnosis of postoperative pain [58]. The normal evolution of scintigraphic uptake after trapeziometacarpal total joint arthroplasty is not known and may differ from the pattern seen after total hip arthroplasty [58].

Other Considerations: The midpoint of the trapezium width is the more relevant radiographic landmark for centering the trapezial prosthetic cup in total joint arthroplasty, as it preserves better bone stock on the radial side without depleting the ulnar side [216]. Subjects presenting with early thumb carpometacarpal joint osteoarthritis had significantly lower bone density as assessed with Hounsfield units at the trapezium and first metacarpal base [213]. The greatest compressive loads at the first carpometacarpal joint occur at the volar-ulnar quadrant of the trapezium, which has significantly greater trabecular bone volume, thickness, and connectivity compared with other quadrants [211].

Treatment

Non-Operative

The absence of disease-modifying treatments has resulted in over 30 different procedures being described for thumb base osteoarthritis, most of which improve pain and health state without a clear mechanism [59]. Evidence indicates that many patients with advanced thumb base osteoarthritis, who are traditionally eligible for operation, do well without surgery [59]. In a prospective cohort study, 85% of patients who did not undergo surgery improved in pain and function, although only improvements in pain were significant and clinically relevant [203]. Patients have prioritized research to avoid surgery, and the last Cochrane review called for a study investigating surgery versus no surgery or a placebo arm [59]. A pragmatic trial comparing trapeziectomy or trapeziectomy with ligament reconstruction and tendon interposition with no surgery would provide information on the efficacy of surgery and the natural history of the condition, with an additional placebo arm being preferable to provide information on the efficacy of surgery [59].

Operative

Indications: Surgery is recommended for patients with isolated trapeziometacarpal joint osteoarthritis, with the Touch prosthesis authors advocating it as the standard treatment [24]. Patients with pain refractory to conservative therapy may benefit from relief and increased hand strength following surgical intervention, including in patients with Ehlers-Danlos Syndrome [182]. Fusion of the first metacarpotrapezial joint is an excellent option for patients needing a strong, painless thumb, even with minor pre-existing changes in adjacent joints [19]. 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, offering advantages including a low rate of complications, low invasiveness, and short recovery times [152].

Surgical Approach / Technique: Trapeziectomy remains the simplest and one of the most established surgical modalities with good long-term outcomes and acceptable side effect profiles [81]. Total trapeziectomy is currently the only surgical technique for thumb basal joint arthritis that can lay claim to being a potential life-long procedure [61]. Ligament reconstruction and tendon interposition leads to very good patient satisfaction and high objective measures of function, including return of strength and dexterity to even the severely affected thumb, with excellent long-term results [1]. The abductor pollicis longus tendon interposition technique restored a stable, pain-free thumb that yielded excellent strength and motion at an average of 5.5 years after the procedure [75]. Although there is some reduction in thumb abduction from 3.5 to 13 years after abductor pollicis longus tendon interposition, other gains after surgery are retained and in some instances slightly improved [9]. The suture suspension arthroplasty technique imparts an ulnarly directed force to the base of the first metacarpal that prevents adduction collapse of the thumb and is typically performed under regional anesthesia, taking approximately 25 to 30 minutes to perform [51, 177]. The "Pillow" technique for thumb carpometacarpal joint arthritis provides pain relief and satisfactory function at an average of 12.5 years after surgery [185]. 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 [74]. After interposition arthroplasty of the thumb followed by two weeks of cast fixation, a thermoplastic short orthotic thumb device should be used [168]. The multiplicity of treatment modalities for carpometacarpal joint arthritis shows that the underlying trapezium excision is probably the prime factor in patients' clinical improvement [187]. Thumb index metacarpal stabilization needs to be based on each individual clinical scenario [187]. The ideal arthroplasty technique has yet to be defined but the chosen technique must be well-suited to the patient’s condition [30].

Implant Selection: The Touch prosthesis demonstrated a 96% implant survival rate at 2 years with promising patient-reported and clinical outcomes [24]. Total joint arthroplasty with a Touch prosthesis may yield a superior biomechanical profile where tendon loads needed to achieve a certain key pinch force are lower and better distributed between actuator muscles compared with trapeziectomy with or without ligament reconstruction [18]. Total joint arthroplasty is able to restore thumb function but cannot fully replicate the kinematics of the healthy trapeziometacarpal joint [12]. Total joint replacement is technically demanding with a potentially higher complication rate [21]. The Elektra prosthesis is an unconstrained, uncemented ball-and-socket prosthesis consisting of a hydroxyapatite-coated titanium stem, a chrome–cobalt steel cup with a hydroxyapatite-coated thread for fixation into the trapezium, and a chrome–cobalt steel head on a neck [189]. Most problems with the Elektra prosthesis derived from the trapezium cup, and only ten of 19 implants showed no sign of failure [188]. The ARPE prosthesis has proven to be a reliable and effective implant for the thumb trapeziometacarpal joint [77]. Trapezial-metacarpal joint replacement using an ARPE implant provides excellent pain relief and good function [183]. In the event of failure, the ARPE implant has uncomplicated potential for salvage [183]. Using a screwed trapezial cup instead of a cemented one appears to prevent loosening and the need for surgical revision [49]. In a series using the same prosthesis, only 23% of stems had cortical contact on postoperative radiographs [39]. Reconstructing the trapezium and inserting a CMI pyrocarbon hemiarthroplasty implant preserves the thumb's projection, length, and stability [176]. The Swanson silastic interposition arthroplasty is an effective treatment option for revision thumb-base surgery provided other treatable causes of poor outcome are excluded, finding good medium-term results and high satisfaction rates [23]. Arthroplasty using a silicone prosthesis can provide immediate and long-term relief of pain and good function in the basal joint of the thumb with arthritis [63]. The use of prosthetic solutions is diminishing owing to concerns about implant stability over time and the risks of failure [73]. Various techniques of resection arthroplasty have not proved to be better than those for trapeziectomy [73].

Alignment / Balancing Strategy: The prosthetic cup in the trapezium should be placed parallel to the proximal articular surface of the trapezium and combined with a metacarpal stem with 7° palmar offset [180].

Pain Management: Pain relief and improved hand function appear to be key determinants of patient satisfaction 5 years after dual-mobility trapeziometacarpal joint implant arthroplasty [32]. Patients had satisfactory power and thumb mobility and continued to be satisfied without pain in a 16–26 year follow-up of De la Caffinière thumb trapeziometacarpal joint arthroplasty [33]. Pain was absent in 60% of patients post-surgery with Schecker's technique, with a mean pain score of 1.6 on an analogue scale [196]. Abductor pollicis longus suspension ligamentoplasty provided excellent pain control with a mean VAS score of 1.7 and allowed patients to return to occupational activities [202].

Adjuncts: 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 [14]. The Wagner approach for first carpometacarpal joint denervation resulted in 14 patients (16 hands) being satisfied or very satisfied with the results in a preliminary report of 18 cases [36]. Arthroscopic debridement and synovectomy techniques for the thumb base have been demonstrated and discussed regarding long-term results [159]. A cosmetic technique for performing basal joint arthroplasty resulted in all patients being satisfied with the relief of their previous pain and their lack of visible scarring, with many patients opting for surgery on their other thumb [62]. The narrow pseudarthrosis technique is a new surgical technique to treat thumb carpometacarpal joint arthritis [73].

Revision: Routine retrieval and analysis of failed trapeziometacarpal joint implants should be considered essential practice within hand surgery [22]. The Swanson silastic interposition arthroplasty is an effective treatment option for revision thumb-base surgery provided other treatable causes of poor outcome are excluded [23].

Other Considerations: In a series of 40 patients, the inclusion criteria for the prosthetic group may have inadvertently favored the selection of more Eaton stage II cases over Eaton stage III cases, potentially introducing bias into the group composition [29]. Prosthesis implantation can be performed in patients with more severe Eaton stages provided specific inclusion criteria are met [29]. Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of the procedure [16]. 1-year postoperative outcomes are similar for tendon arthroplasty and total joint replacement [15]. It is crucial to delve into the comparative efficacy, long-term outcomes, and potential complications associated with tendon arthroplasty and total joint replacement [15]. While pain relief is generally good in hand arthroplasty, there are high rates of deformity recurrence and complications depending on the implant type and joint involved [6]. There is no standardized data set required by major hand journals or recommended by hand surgeon bodies for functional scores in implant arthroplasty studies [11]. There is a lack of consensus on critical outcomes after surgery for thumb CMC joint osteoarthritis [20]. CMC joint arthrodesis prevents movement in the joint and results in a non-union in a significant number of cases, up to 12.5% [73]. Steps to slow thumb shortening after surgery, such as pinning or rebuilding the joint with a ligament, have higher complication rates and have not proved to be beneficial in the long run [178]. Implanting foreign materials has resulted in complications and a need for repeat surgeries [178]. "Thumb replacement" may have a short lifespan, particularly if the patient wants to remain active [178]. LRTI still predominates among surgical options for thumb carpometacarpal arthritis, but nonprosthetic arthroplasty was the only cohort increasing in utilization over the years from 2010 to 2022 [64]. There is scepticism regarding implant arthroplasty, and the priority should be establishing the efficacy of trapeziectomy over non-surgical treatments rather than comparing it with other surgical techniques [59]. The current evidence supports trapeziectomy alone [59]. One thumb CMC joint was still painful and was reoperated and converted to arthroplasty after 4.4 years following autologous chondrocyte transplantation [8].

Complications

Implant Survival and Loosening: The Touch® trapeziometacarpal joint arthroplasty demonstrated a 96% implant survival rate at 2 years [24]. Total joint replacement for the thumb carpometacarpal joint is technically demanding and carries a potentially higher complication rate compared to other surgical treatments [21]. Several implant designs for thumb carpometacarpal joint osteoarthritis have shown high rates of failure due to aseptic loosening, dislocation, and persisting pain [231]. The Elektra prosthesis experienced frequent loosening before 18 months in early versions, with a rate that never dropped below 17% at 4 years [205]. The ARPE prosthesis showed cup loosening in 10 patients (4.6%) and dislocation in 12 prostheses (5.3%) over a minimum 10-year follow-up [169]. The uncemented thumb carpometacarpal joint ceramic prosthesis had an unacceptably high rate of early aseptic failure [233]. The cementless thumb basal joint hemiarthroplasty reported early clinical failure, contrasting with previous literature that reported 94% survivorship [235]. The Moje thumb carpometacarpal joint arthroplasty exhibited a high frequency of failure [56]. Adverse radiographic findings were nearly universal in patients treated with spherical ceramic trapezial-metacarpal arthroplasty [50]. The Maïa® trapeziometacarpal joint arthroplasty has high complication and revision rates that remain a major concern [236]. Using a screwed trapezial cup instead of a cemented one appears to prevent loosening and the need for surgical revision in the ISIS® prosthesis [49]. Routine retrieval and analysis of failed trapeziometacarpal joint implants is advocated as essential practice within hand surgery [22].

Periprosthetic Fracture: Perioperative complications for the ARPE prosthesis included trapezium fractures in three patients and excessive trapezium osteotomies in two patients, both of which resulted in failed prostheses [169]. One case of stem penetration of the thumb metacarpal cortex occurred with the ARPE prosthesis, which remained functional in situ without evidence of loosening [169].

Nerve Palsy and Neurological Complications: Thirteen patients treated with the ARPE prosthesis complained of moderate paraesthesia or dysesthesia dorsally on the thumb, with two reporting persistent symptoms at the 10-year review [169]. A patient treated with a cemented surface replacement prosthesis experienced neurapraxia of the radial nerve, presumably from injury to the sensory branch during surgery, resulting in neurogenic thumb pain and loss of function [165]. Cutaneous nerve damage was the primary complication discovered during follow-up in a comparison of arthrodesis and arthroplasty, with 5 cases of numbness at the surgical site [161]. Potential complications of Double Tightrope for basilar thumb arthritis include infection, sensory nerve irritation, radial artery injury, injury to the FCR tendon during bone removal, and postoperative subsidence with weakness and recurrence of pain [175].

Soft Tissue and Other Complications: Three patients treated with the ARPE prosthesis experienced transient complex regional pain syndrome type I [169]. Five cases of suture reaction were observed in the ARPE prosthesis series [169]. Reflex sympathetic dystrophy occurred in 5 patients, transient oedema of the hand in 2, trigger thumb in 1, carpal tunnel compression in 3, and loss of first metacarpal abduction in 4 following Weilby tendon interposition arthroplasty [122]. Index metacarpal fracture after suture button suspensionplasty has been reported [175].

Infection (PJI): There was no evidence of deep infection in the ARPE prosthesis series with a minimum 10-year follow-up [169]. A patient treated with a cemented surface replacement prosthesis developed an infection after a fall and subsequent prosthesis replacement, which was salvaged by trapeziectomy with tendon interposition [165]. The incidence of periprosthetic joint infection among patients with rheumatoid arthritis is 1.6 times greater than in patients undergoing the same procedure for osteoarthritis [232]. TJA cases following an infected case in the same room on the same day have a higher infection risk, although surgical case order is not an independent risk factor for subsequent PJI [217].

Other Considerations: The risk of new surgery following revision of trapeziectomy was between zero and 17% in series that approached or exceeded 20 patients with medium-term follow-up [163]. Small series of trapeziectomy revision have reported reoperation rates exceeding 50% [163]. Outcomes after revision surgery for thumb carpometacarpal resection arthroplasty were less favourable than those reported for primary trapeziectomy with ligament reconstruction and tendon interposition [37]. Results after revision of interposition implant trapeziometacarpal arthroplasty may be worse than previously described and show a tendency for worse results than those of primary arthroplasty [222]. The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the results of primary trapeziectomy [92]. Prosthetic replacement is preferred in cases of loosening when technically possible to preserve the thumb’s length [25]. CMC arthroplasty has a very low overall complication rate of 1.3% and a wound complication rate of 0.66% according to the American College of Surgeons National Surgery Quality Improvement Program [237]. While pain relief after hand arthroplasty is generally good, there are high rates of deformity recurrence and complications depending on the implant type and joint involved [6]. The overall complication rate for trapezio-metacarpal arthroplasty is limited, supporting its status as a long-term reliable solution for thumb carpometacarpal osteoarthritis [221]. The published evidence does not show that total arthroplasty is better than trapeziectomy and its variants, yet there is a higher complication rate and significant extra cost of using an implant [224]. Reoperation rates and superficial infections with the described method of fixation for thumb metacarpal extension osteotomy were relatively high [174]. No intraoperative complications were reported in a study comparing accelerated versus traditional rehabilitation after arthroscopic distal scaphoid resection [134].

Recovery

Rehabilitation protocol: Postoperative management for thumb carpometacarpal arthroplasty predominantly relies on clinical expertise, with multiple therapy programs in use [149]. Early mobilization following trapeziectomy is as safe and effective as longer immobilization regimens for first carpometacarpal osteoarthritis [171]. The Tightrope procedure is associated with reduced healing time, fewer weeks of immobility, and fewer therapy visits compared to other arthroplasty options [74]. Home-based video-assisted therapy is noninferior to in-person hand therapy for upper extremity function [76]. Patients who underwent hand therapy prior to surgery had significantly longer times to the procedure than those who did not [13].

Functional milestones: Long-term outcomes demonstrate that trapeziectomy and tendon suspension-interposition arthroplasty provides predictable results, with pain and function comparable to unoperated sides at long-term follow-up [220]. Abductor pollicis longus tendon interposition restores a stable, pain-free thumb with excellent strength and motion at an average of 5.5 years [75]. Although thumb abduction may reduce from 3.5 to 13 years after abductor pollicis longus tendon interposition, other functional gains are retained or slightly improved [9]. Ligament reconstruction and tendon interposition leads to very good patient satisfaction and high objective measures of function, including return of strength and dexterity in severely affected thumbs [1]. Both ligament reconstruction and tendon interposition and hematoma distraction arthroplasty satisfy the principal goals of providing a stable, mobile, pain-free thumb [79]. Total joint arthroplasty in primary trapeziometacarpal arthritis results in low pain levels, excellent mobility, and high patient satisfaction [227]. Patients report satisfactory power and thumb mobility without pain at 16–26 year follow-up after De la Caffini thumb trapeziometacarpal joint arthroplasty [33]. In modified suture suspension arthroplasty, no relationship of significance exists between postoperative first metacarpal subsidence and functional outcomes [228].

Other Considerations: First metacarpal extension osteotomy is an effective and durable procedure that does not limit future salvage procedures such as trapeziectomy or arthroplasty [208]. One thumb carpometacarpal joint treated with autologous chondrocyte transplantation remained painful and was reoperated and converted to arthroplasty after 4.4 years [8]. Outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from primary trapeziectomy results [92]. Despite relatively satisfactory implant survivorship in the Norwegian Arthroplasty Register, current evidence does not support widespread implementation of thumb carpometacarpal replacements [85]. There is a lack of consensus on critical outcomes after surgery for thumb carpometacarpal joint osteoarthritis [20]. Patients' prior surgical experience and surgeon attitudes toward thumb carpometacarpal arthritis strongly influence the odds of patients undergoing surgery [35]. Total joint replacement offers advantages over other 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 [21]. Given that 1-year postoperative outcomes are similar for tendon arthroplasty and total joint replacement, it is crucial to investigate comparative efficacy, long-term outcomes, and potential complications associated with each surgical approach [15].

Key Evidence

• [L4] The procedure described leads to very good patient satisfaction and high objective measures of function, including return of strength and dexterity to even the severely affected thumb, with excellent long-term results. [1] (10.1016/j.hcl.2012.08.018)
• [L4] This series demonstrates that thumb arthroplasty is a reliable long-term solution for thumb base arthritis, with significant pain reduction and functional improvement, even after 15 years of follow-up. [3] (10.1177/15589447241233367)
• [L4] In our series, total joint arthroplasty of the thumb CMC joint has proven to be efficacious with improved motion, strength, and pain relief. [4] (10.1016/j.jhsa.2006.08.008)
• [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. [5] (10.1177/17531934231197787)
• [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. [6] (10.1177/17531934211017703)
• [L5] The procedure results in a stable thumb with pain relief. [7] (10.1097/bth.0000000000000048)
• [L4] One thumb CMC joint was still painful and was reoperated and converted to arthroplasty after 4.4 years. [8] (10.1016/j.hansur.2020.11.008)
• [L3] Although there is some reduction in thumb abduction from 3.5 to 13 years after surgery, other gains after surgery are retained and in some instances slightly improved. [9] (10.1186/s12891-016-0910-5)
• [L4] Long-term results are necessary to establish its place within the treatment armamentarium of thumb basal joint arthritis. [10] (10.1097/bth.0b013e318190c1e7)
• [L4] There is no standardized data set required by major hand journals or recommended by hand surgeon bodies, and functional scores are used infrequently in studies on implant arthroplasty despite their importance. [11] (10.1177/1753193419883968)
• [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. [12] (10.1016/j.jhsa.2017.10.011)
• [L2] Patients treated with hand therapy had significantly longer times to surgery, and the 2-year surgery rates were significantly higher in those who did not undergo therapy treatment. [13] (10.1016/j.jhsa.2023.05.019)
• [L5] Although indications for this technique are limited, we believe it adds an additional option for complicated cases of thumb base arthritis. [14] (10.1097/bth.0000000000000045)
• [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. [15] (10.1177/17531934231206267)
• [L5] Limiting the magnitude of thumb loads after arthroplasty may contribute positively to the longevity of this procedure. [16] (10.1177/1753193416659230)
• [L1] Furthermore, proximal migration of the thumb metacarpal does not appear to influence the functional outcome. [17] (10.2106/jbjs.d.02630)
• [L5] Total joint arthroplasty with a Touch prosthesis may yield a superior biomechanical profile in which the tendon loads needed to achieve a certain key pinch force are lower and better distributed between the actuator muscles compared with trapeziectomy with or without ligament reconstruction. [18] (10.1177/17531934211015915)
• [L4] It is an excellent option for patients needing a strong, painless thumb, even with minor pre-existing changes in adjacent joints. [19] (10.2106/00004623-197759010-00003)
• [L1] There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. [20] (10.1016/j.jhsa.2020.05.024)
• [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. [21] (10.1530/eor-22-0027)
• [L5] The authors advocate that routine retrieval and analysis of failed trapeziometacarpal joint implants be considered essential practice within hand surgery. [22] (10.1177/17531934261452468)
• [L4] The study found good medium-term results and high satisfaction rates, advocating the technique as an effective treatment option for revision thumb-base surgery provided other treatable causes of poor outcome are excluded. [23] (10.1177/1753193412447496)
• [L4] The study reports a 96% implant survival rate at 2 years with promising patient-reported and clinical outcomes, leading the authors to recommend surgery with the TouchRV prosthesis as the standard treatment for patients with isolated trapeziometacarpal joint osteoarthritis. [24] (10.1177/17531934231179581)
• [L5] Prosthetic replacement is preferred in case of loosening when it is technically possible in order to preserve the thumb’s length. [25] (10.1016/j.hansur.2020.08.010)
• [L3] Three-dimensional assessment of thumb kinematics can enhance understanding of expected outcomes and aid in postoperative assessment and patient education. [26] (10.1177/17531934251393568)
• [L5] This review provides an overview of different radiological views described for the thumb, emphasizing their historical origin and positioning, and describes various measurements and classifications used to evaluate the trapeziometacarpal joint. [27] (10.1177/17531934221137979)
• [L4] [28] (10.2106/00004623-199503000-00003)
• [L3] [29] (10.1016/j.jhsg.2024.03.004)
• [L5] The ideal arthroplasty technique has yet to be defined but nevertheless, the chosen technique must be well-suited to the patient’s condition. [30] (10.1016/j.hansur.2016.06.002)
• [L4] Pain relief and improved hand function appear to be key determinants of patient satisfaction. [32] (10.1177/17531934261468204)
• [L4] Patients had satisfactory power and thumb mobility and continued to be satisfied without pain. [33] (10.1177/1753193411433226)
• [L3] The metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens. [34] (10.1055/s-0033-1350088)
• [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. [35] (10.1016/j.jhsa.2021.02.009)
• [L4] In a preliminary report of 18 cases, 14 patients (16 hands) were satisfied or very satisfied with the results and would have the operation again. [36] (10.1097/bth.0b013e31824f8c96)
• [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. [37] (10.1177/17531934211050559)
• [L4] In our series, the same prosthesis was implanted, but only 23% of our stems had cortical contact on postoperative radiographs. [39] (10.1177/1753193417733377)
• [L4] Using a screwed trapezial cup instead of a cemented one appears to prevent loosening and the need for surgical revision. [49] (10.1177/17531934221123166)
• [L4] Although most patients were satisfied with their function and pain relief, adverse radiographic findings were nearly universal. [50] (10.1016/j.jhsa.2008.10.017)
• [L5] The suspension also imparts an ulnarly directed force to the base of the first metacarpal that prevents adduction collapse of the thumb. [51] (10.1097/bth.0b013e3181d74c72)
• [L4] [52] (10.1016/s0749-0712(21)00240-7)
• [L5] It provides excellent strength, satisfactory thumb range of motion, and excellent patient satisfaction. [53] (10.1097/00130911-200212000-00004)
• [L5] [54] (10.1016/j.hcl.2010.05.006)
• [L4] [56] (10.1177/1753193412454252)
• [L4] [57] (10.1177/1753193420906805)
• [L4] [58] (10.1177/17531934251345359)
• [Letter] [59] (10.1177/17531934211008365)
• [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. [61] (10.1016/j.hansur.2020.05.015)
• [L4] All patients were satisfied with the relief of their previous pain and their lack of visible scarring, with many opting for surgery on their other thumb. [62] (10.1097/01.bth.0000189837.95670.ed)
• [L4] Arthroplasty using a silicone prosthesis can provide immediate and long-term relief of pain and good function in the basal joint of the thumb with arthritis. [63] (10.2106/00004623-198769070-00006)
• [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. [64] (10.1016/j.jhsa.2025.03.014)
• [L4] Radiographic assessment showed only one scaphoid cup loosening, and measurement of the length of the thumb column showed a shortening of 0.2 cm after surgery. [66] (10.1016/j.hansur.2017.10.077)
• [L5] [69] (10.1016/s0749-0712(21)00238-9)
• [L4] The authors reviewed results in 65 patients (66 thumbs) and found that bone union was confirmed radiographically after a mean of 6 weeks. [71] (10.1097/bth.0b013e3181d148cb)
• [L5] The paper describes clinical assessment of the thumb trapeziometacarpal joint, noting a poor correlation between radiographic severity of degenerative disease and clinical symptomatology. [72] (10.1016/s0749-0712(21)00239-0)
• [L4] [73] (10.1177/1753193412469127)
• [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. [74] (10.1016/j.jht.2013.12.012)
• [L4] This technique restored a stable, pain-free thumb that yielded excellent strength and motion at an average of 5.5 years after the procedure. [75] (10.1016/j.jhsa.2011.05.026)
• [L1] VOT was noninferior to IPT for upper extremity function after thumb CMC arthroplasty. [76] (10.2106/jbjs.23.00597)
• [L4] The ARPE prosthesis of the thumb TMC joint has proven to be a reliable and effective implant. [77] (10.1016/j.jhsa.2017.05.007)
• [L3] Both groups satisfied the principal goals to provide a stable, mobile, pain-free thumb. [79] (10.1016/j.jhsa.2010.08.034)
• [L1] Trapeziectomy remains the simplest and one of the most established surgical modalities with good long-term outcomes and acceptable side effect profiles. [81] (10.1016/j.jhsg.2024.12.005)
• [L4] [82] (10.1016/j.jhsa.2014.11.026)
• [L3] Despite relatively satisfactory implant survivorship in our register study, current evidence does not support widespread implementation of thumb CMC replacements. [85] (10.1177/1753193413513988)
• [L5] The study established consensus recommendations for six common revision scenarios using a rigorous Delphi process involving experienced hand surgeons worldwide. [88] (10.1177/17531934241227386)
• [L3] The radiological classification does not describe all stages of carpometacarpal joint osteoarthritis accurately enough to permit reliable and consistent communication between clinicians. [89] (10.1016/j.jhsa.2014.09.007)
• [L3] The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results. [92] (10.1016/j.jhsa.2013.01.030)
• [L5] These data may be useful for helping the understanding of the biomechanics of the basal joint of the thumb. [102] (10.1016/j.main.2006.09.002)
• [L5] Wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model. [109] (10.1016/j.jhsa.2019.10.003)
• [L5] Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage OA. [111] (10.1016/j.jhsa.2007.02.009)
• [L3] Thumb motion capability was unaffected by sex and handedness. [112] (10.1016/j.jhsa.2014.08.012)
• [L5] Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes. [113] (10.5435/jaaos-d-17-00374)
• [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. [116] (10.1007/s11999-016-5151-2)
• [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. [119] (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. [120] (10.1016/j.jhsa.2017.07.028)
• [L4] [122] (10.1016/0266-7681(87)90062-3)
• [L5] This biomechanical cadaver study supports the hypothesis that trapeziectomy results in proximal migration of the first metacarpal, which is mitigated by suture suspensionplasty while maintaining normal motion. [124] (10.1016/j.jhsa.2022.05.001)
• [L3] Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis. [125] (10.1177/17531934251383073)
• [L4] The automated approach significantly decreased the time needed to analyse each case and makes this model applicable for further research on TMC kinematics. [127] (10.1177/17531934241229948)
• [L3] Ergonomic solutions are necessary to decrease thumb motions or strenuous effort encountered at work, especially for women. [128] (10.1016/j.jhsa.2007.01.014)
• [Paper] This study contributes to a further understanding of the biomechanics of the intact and surgically repaired TMC joint and addresses the biomechanical consequences of changing a joint’s DoF by surgery. [130] (10.1002/jor.21453)
• [L4] Directionally coupled motion patterns in the CMC joint are similar in men and women. [131] (10.1007/s11999-013-3063-y)
• [L5] The decrease in key pinch force was larger than the relatively small increase in thumb CMC force. [132] (10.1016/j.jhsa.2022.11.018)
• [L4] The dominant postoperative effect was palmar loading with reduced dynamic variability. [133] (10.1007/s00402-026-06455-5)
• [L4] [134] (10.1016/j.jhsa.2016.07.019)
• [L5] Dorsal inclination of the cup should be avoided as it increases the risk of dislocation during thumb flexion and opposition. [141] (10.1177/1753193419851775)
• [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. [142] (10.1016/j.jhsa.2018.01.002)
• [L4] This study demonstrates that multiple therapy programs exist and rehabilitation following thumb CMC arthroplasty predominantly utilizes clinical expertise. [149] (10.1016/j.jht.2020.10.016)
• [L3] The high prevalence of other symptomatic disorders of the hand requires a complete and standardized clinical examination of the hand, as they must be considered during surgical planning. [150] (10.1177/17531934231220644)
• [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. [152] (10.1177/1753193416632149)
• [L2] Patients with TMC OA predominantly visit hand surgeons seeking treatment to reduce pain, whereas function and aesthetics have minor roles. [158] (10.1016/j.jhsa.2014.10.066)
• [L4] Long-term results of arthroscopic debridement and synovectomy, the surgical techniques, and the examples of arthroscopic assisted procedures at the thumb base were demonstrated and discussed. [159] (10.1177/1558944716660555r)
• [L3] [161] (10.1186/s13018-019-1469-2)
• [L5] The anatomically based radiological classification that is proposed here aims to differentiate between the different forms of thumb basal joint arthritis so as to allow a prospective study to assess the results. [162] (10.1016/j.hansur.2020.04.013)
• [L4] [163] (10.1016/j.hansur.2021.03.014)
• [L4] [164] (10.1177/17531934251346310)
• [L4] [165] (10.1016/j.jhsa.2009.12.026)
• [L1] After interposition arthroplasty of the thumb followed by two weeks cast fixation, a thermoplastic short orthotic thumb device should be used. [168] (10.1186/s12891-025-08433-1)
• [L2] [169] (10.1177/1753193419871660)
• [L2] A postoperative regimen with early mobilization after trapeziectomy is as safe and effective as a postoperative regimen with longer immobilization in patients with first carpometacarpal osteoarthritis. [171] (10.1016/j.jhsa.2021.08.015)
• [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. [173] (10.1177/1558944718765246)
• [L4] Although reoperation rates and superficial infections with the described method of fixation were relatively high, thumb metacarpal osteotomy provides some degree of pain relief and improvement of function. [174] (10.1016/j.jhsa.2018.01.005)
• [L4] [175] (10.1016/j.jhsa.2014.09.012)
• [L4] Reconstructing the trapezium and inserting this hemiarthroplasty implant preserves the thumb's projection, length, and stability. [176] (10.1016/j.otsr.2021.102984)
• [L5] [177] (10.1097/bth.0b013e3181b4c388)
• [L5] [178] (10.1016/j.jhsa.2008.11.028)
• [L4] The study suggests that in thumb carpo-metacarpal total joint arthroplasty, the prosthetic cup in the trapezium should be placed parallel to the proximal articular surface of the trapezium and combined with a metacarpal stem with 7° palmar offset. [180] (10.1177/1753193416630496)
• [L4] Patients with pain refractory to conservative therapy may benefit from relief and increased hand strength following surgical intervention. [182] (10.1177/1753193418785825)
• [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. [183] (10.1016/j.jhsa.2013.08.073)
• [L4] This technique provides pain relief and satisfactory function at an average of 12.5 years after surgery. [185] (10.1016/j.jhsa.2016.04.018)
• [L5] The multiplicity of treatment modalities for carpometacarpal joint arthritis shows that the underlying trapezium excision is probably the prime factor in patients' clinical improvement, and thumb index metacarpal stabilization needs to be based on each individual clinical scenario. [187] (10.1016/j.jhsa.2007.02.013)
• [L3] Most problems derived from the trapezium cup, and only ten of the 19 implants showed no sign of failure. [188] (10.1177/1753193411414505)
• [L3] [189] (10.1177/1753193419873230)
• [L4] Pain was absent in 60% of patients post-surgery, with a mean pain score of 1.6 on an analogue scale. [196] (10.1016/s0363-5023(03)80376-3)
• [L4] [199] (10.1016/j.jhsa.2011.03.035)
• [L4] The procedure provided excellent pain control with a mean VAS score of 1.7 and allowed patients to return to occupational activities. [202] (10.4055/cios.2015.7.3.372)
• [L2] The patients (85%) who did not undergo surgery improved in pain and function, although only improvements in pain were significant and clinically relevant. [203] (10.1016/j.jhsa.2018.04.014)
• [L2] Radiographic analysis showed a constant lengthening of the thumb column after PTM and a shortening after TL. [204] (10.1016/j.hansur.2017.10.076)
• [L4] The main complication was loosening, which occurred frequently before 18 months in early versions, with a rate never dropping below 17% at 4 years. [205] (10.1016/j.main.2013.10.082)
• [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. [207] (10.1016/j.jhsa.2015.04.038)
• [L4] Our data suggest that first metacarpal extension osteotomy can be an effective and durable procedure that does not limit future salvage procedures such as trapeziectomy or arthroplasty and support use of this treatment in early and moderate Eaton stages. [208] (10.1016/j.jhsa.2008.08.003)
• [L4] The significantly greater trabecular bone volume, thickness, and connectivity in the volar-ulnar quadrant compared with the dorsal-radial and dorsal-ulnar quadrants provides evidence that the greatest compressive loads at the first carpometacarpal joint occur at the volar-ulnar quadrant of the trapezium, representing a consistently affected region of wear in both normal and arthritic states. [211] (10.1016/j.jhsa.2012.10.038)
• [L3] Trapeziometacarpal arthroplasty, even after radiographic failure, still served as a spacer, avoiding collapse of the thumb base. [212] (10.1177/1558944720930297)
• [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). [213] (10.1016/j.jhsa.2017.09.004)
• [L4] Our study thus suggested that the midpoint of the trapezium width is the more relevant radiographic landmark for centering the trapezial prosthetic cup in total joint arthroplasty, by preserving better bone stock on the radial side without depleting the ulnar side. [216] (10.1016/j.hansur.2021.05.002)
• [L3] Although surgical case order is not an independent risk factor for subsequent PJI, TJA cases following an infected case in the same room on the same day have a higher infection risk. [217] (10.1016/j.arth.2017.02.029)
• [L4] Comparable pain and function between operated and unoperated sides at long-term follow-up suggests that trapeziectomy and tendon suspension-interposition arthroplasty provides predictable outcomes, and surgeons can use these data to counsel patients that surgery can potentially return them to comparable use. [220] (10.1097/corr.0000000000001795)
• [L4] Trapezio-metacarpal arthroplasty is a long-term reliable solution for surgical treatment of thumb carpometacarpal osteoarthritis, with a limited complication rate. [221] (10.1016/j.hansur.2019.10.097)
• [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. [222] (10.1177/15589447211028920)
• [L1] The published evidence does not show that total arthroplasty is better than trapeziectomy and its variants, yet there is a higher complication rate and significant extra cost of using an implant. [224] (10.1177/1753193414563243)
• [L3] Total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function with high patient satisfaction. [227] (10.1186/s12891-024-07439-5)
• [L4] A relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear. [228] (10.1177/1558944719886669)
• [L1] Several implant designs had high rates of failure due to aseptic loosening, dislocation, and persisting pain. [231] (10.1016/j.jhsa.2019.05.003)
• [L4] The incidence of periprosthetic joint infection among patients with rheumatoid arthritis is 1.6 times greater than in patients undergoing the same procedure for osteoarthritis, potentially due to immunosuppressive therapies. [232] (10.1016/j.arth.2017.11.031)
• [L4] The rate of early aseptic failure was unacceptably high. [233] (10.1177/1753193416688427)
• [L4] The study reports early clinical failure of the cementless thumb basal joint hemiarthroplasty, contrasting with previous literature that reported 94% survivorship. [235] (10.1016/j.jhsa.2016.07.021)
• [L4] However, the high complication and revision rates are still a major concern. [236] (10.1016/j.hansur.2019.03.004)
• [L3] CMC arthroplasty has a very low overall complication rate of 1.3% and wound complication rate of 0.66%. [237] (10.1177/1558944717744341)

See Also

• Trapeziectomy
• Basal Thumb Arthritis
• Strength and Motion
• Thumb CMC arthroplasty

References

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[11] Functional outcomes after surgery for thumb carpometacarpal joint arthritis. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419883968

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[15] Re: Herren DB, Marks M, Neumeister S, Schindele S. Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis. J Hand Surg Eur. 2023. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231206267

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[17] Ligament Reconstruction with or without Tendon Interposition to Treat Primary Thumb Carpometacarpal Osteoarthritis. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.d.02630

[18] Comparison of simulated key pinch after three surgical procedures for trapeziometacarpal osteoarthritis: a cadaver study. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211015915

[19] Fusion of the first metacarpotrapezial joint for degenerative arthritis. The Journal of Bone & Joint Surgery. 1977. DOI: 10.2106/00004623-197759010-00003

[20] Reporting Outcomes and Outcome Measures in Thumb Carpometacarpal Joint Osteoarthritis: A Systematic Review. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.05.024

[21] Total joint replacement for osteoarthritis of the carpometacarpal joint of the thumb: why and how?. EFORT Open Reviews. 2022. DOI: 10.1530/eor-22-0027

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