trapeziectomy

A trapeziectomy is a surgical procedure in which the trapezium, one of the small carpal bones at the base of the thumb, is removed. It is most commonly performed to treat osteoarthritis of the first carpometacarpal (CMC-1) joint, particularly when pain and loss of function persist despite nonoperative treatment. The procedure can also be used for certain fracture-dislocations or other degenerative conditions affecting the CMC-1 joint.

Most trapeziectomies are performed for advanced basilar thumb arthritis (often Eaton-Littler stages II to IV) when joint surfaces are eroded and pain limits function. The goal is to relieve pain while preserving thumb movement and grip strength. The operation is typically considered after failure of conservative measures, such as splinting, activity modification, and medications.

Surgical techniques vary. A simple trapeziectomy removes the trapezium alone. Many surgeons augment the procedure with a tendon-based reconstruction or interposition to restore thumb length and stabilize the metacarpal base. Common approaches include ligament reconstruction and tendon interposition (LRTI), which uses a slip of the flexor carpi radialis tendon to reconstruct a ligamentous support and fill the space, and suspension techniques that suspend the first metacarpal to adjacent structures. Some surgeons perform trapeziectomy with interposition alone, or combine it with other stabilization methods.

Postoperative care usually involves immobilization in a splint or cast for several weeks, followed by rehabilitation to restore range of motion and strength. Expected outcomes include relief of pain and improved function for many patients, but there can be residual weakness, changes in thumb length or alignment, and rare complications such as stiffness, infection, or nerve injury. Overall, trapeziectomy remains a widely used option for selected patients with basilar thumb arthritis.