Trapeziectomy Info Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
This page reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic. You reach our clinic by GP or physiotherapist referral. A clinic assessment establishes the diagnosis. For degenerative problems we usually try non-operative care first. We consider surgery when that has not given enough improvement.
Trapeziectomy removes the small bone at the base of your thumb to treat wear-and-tear arthritis. This creates space so your thumb bone rests on your wrist bone. We recommend this when pain and stiffness limit your daily tasks. The operation aims to deliver significant and sustained improvement in function and pain relief.
Before the operation
We ask you to fast for six hours before your surgery. Please stop taking blood-thinning medications as your surgeon will advise. Arrange a lift home and bring a list of all current medicines. You will need an X-ray to check your thumb joint and a blood test to ensure you are fit for anaesthesia. An anaesthetic review helps us plan your comfort. On the day, wear loose, comfortable clothing. Your surgeon performs this as an open operation using a single incision over the thumb base. This allows direct access to remove the worn bone. Keep your phone charged and your mind calm. We will guide you through every step.
On the day
This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief — the anaesthetist decides on the day based on your individual circumstances.
You will arrive at the hospital for admission. You will meet your anaesthetist to discuss your care plan. Then you will go into the operating theatre. Your surgeon performs this as an open approach with a single conventional incision over the operative site. You will wake up in recovery afterwards. We will monitor your comfort and stability. You can expect to rest while the anaesthetic wears off.
What the operation involves
Your surgeon makes a single cut over the base of your thumb to reach the joint. This open approach allows clear access to the trapezium bone, which sits at the base of your thumb where it meets the wrist. The trapezium is a small, cube-shaped bone that acts as a pivot for your thumb movements.
Once the area is exposed, your surgeon removes the entire trapezium bone. This is known as a total trapeziectomy. We do not perform partial removals, as evidence shows they offer no advantage over removing the whole bone at one year after surgery. We also do not remove the nearby trapezoid bone, as this is not recommended when we use tendon suspension techniques.
After the bone is removed, your surgeon may use a tendon from your forearm or wrist to help stabilise the space. This tendon acts like a soft cushion or sling, holding your thumb bone in a comfortable position while it heals. We do not use temporary metal wires to hold the bones in place, as the value of this extra step remains unproven. We also do not use suture button fixation devices at this stage, as more data is needed before we consider them standard practice.
The cut is then closed with stitches or staples, and a dressing is applied. The procedure focuses on removing the worn joint surfaces to relieve pain and improve function.
After the operation
You will wake up in the recovery ward with your hand in a sling and a protective dressing. Most patients stay one night in hospital after this operation, though some are able to go home the same day. Your surgeon will manage your pain using standard methods. You must have someone stay with you for the first 24 hours. We use an open approach with a single conventional incision over the operative site. You will wear a thumb spica splint for four to six weeks. Do not drive while the splint is on, as it stops you from gripping the wheel safely. You may drive once the splint is removed and your surgeon clears you. See Driving after upper-limb surgery.
Recovery
You can expect some pain and swelling in the days and weeks after your trapeziectomy. This is normal as your body heals from the open incision over your thumb base. We manage this discomfort with prescribed medication and by keeping your hand elevated above your heart as much as possible. Ice packs applied gently to the area can also help reduce swelling.
For the first few weeks, you will wear a thumb spica splint to protect your hand. You must not drive while wearing this splint, as it prevents you from gripping the steering wheel safely. You can still use your other hand for daily tasks, but we advise avoiding heavy lifting or forceful gripping with the operated hand. At night, try sleeping on your back or on your non-operated side to keep the swelling down.
As the swelling settles and your surgeon clears you to remove the splint, you will begin gentle movement exercises. Hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation, who will guide you through these steps. You will gradually reintroduce light activities like writing or typing as movement returns. Milestones are based on how your hand feels, such as when you can grip without pain. Your timeline may differ; your surgeon and physio will guide you.
What can go wrong
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
If you have had a previous joint replacement in your thumb that did not work, removing the bone and starting fresh is a known option. This secondary surgery generally provides results similar to the first time you had the procedure. You should expect a period of healing and rehabilitation, but the outcome is typically comparable to a primary operation.
Sometimes, the thumb may feel stiff or less flexible than expected. You might notice a clicking or grinding sensation when you move your thumb base. This can happen if the space between the bones changes shape as it heals. If this sensation becomes painful or limits your daily tasks, bring it up at your next review. We can discuss whether specific exercises might help improve your movement.
In rare cases, the wound may not heal as smoothly as planned. You might see redness spreading out from the incision site, or notice increased swelling and tenderness. If the area feels hot to the touch or if you develop a fever, this could signal an infection. Contact our clinic immediately if you notice these signs. Early attention helps us manage the issue before it becomes more serious.
You may also experience persistent pain that does not ease with simple painkillers. While trapeziectomy usually brings significant relief, some people find that discomfort lingers longer than expected. If your pain remains severe or worsens after the initial healing phase, please call us. We can assess whether this is part of the normal recovery process or if further investigation is needed.
The complications table on this page lists typical rates if you want the specifics.
When to call us
Call us if you have a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or inability to move your limb. Complications can occur despite careful care. We want to help you recover safely. Contact our team immediately if any of these signs appear.
