Trapeziectomy Info Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. 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. It is typically offered when wear-and-tear arthritis causes persistent pain or stiffness. Your surgeon may recommend it to relieve pain and improve hand function. Evidence shows this procedure significantly reduces pain in 80% of patients over 12 months. It also provides sustained improvement in daily hand use.
Before the operation
If you have other medical conditions, you may need blood tests or a review with the anaesthetist before surgery. You may also need X-rays or an MRI to check your joint condition. Please fast for the time your surgeon specifies. Stop taking certain medications as advised. Arrange for someone to drive you home. Bring a list of all your current medicines. Wear comfortable clothing that is easy to remove. We will guide you through each step so you feel prepared and confident before your procedure.
On the day
You present to the hospital’s surgical admissions unit. You are checked in and prepared for theatre. You meet the anaesthetist to discuss your care. 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 are then taken into the operating theatre, where the operation is performed. You wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable you either go to the ward or go home, depending on the procedure and your recovery.
What the operation involves
Your surgeon makes a single cut over the base of your thumb to access the joint. This open approach allows clear visibility of the area that needs treatment. Inside, your surgeon removes the trapezium bone, which is the small bone at the base of your thumb that has become worn out. This bone is part of the trapeziometacarpal joint, also known as the basilar joint.
In some cases, your surgeon may perform a simple trapeziectomy, which involves just removing the bone. Alternatively, your surgeon might use a ligament reconstruction and tendon interposition (LRTI) technique. For this, your surgeon takes a small piece of tendon from nearby and places it into the space where the bone was removed. This acts like a cushion to help maintain the shape and function of your thumb. Your surgeon may also use a thin wire, called a Kirschner wire, to hold the thumb bone in place temporarily while things settle. This wire is usually removed later in your recovery.
Once the bone work is complete, your surgeon closes the cut with stitches. These stitches may dissolve on their own or need to be taken out by your nurse or doctor. A dressing is applied to protect the area as it begins to heal. The procedure focuses on removing the source of pain and restoring movement to your thumb.
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. We will manage your pain with standard medication. Keep your arm elevated to reduce swelling. You must have someone stay with you for the first 24 hours. Do not drive while wearing the thumb spica splint, as it stops you from gripping the wheel safely. You can only drive once the splint is removed and your surgeon clears you. See Driving after upper-limb surgery for more details.
Recovery
You can expect some pain and swelling in the first few days. This is normal. Your surgeon will guide you on pain relief to keep you comfortable. Resting your hand above heart level helps reduce swelling.
You will wear a thumb spica splint for four to six weeks. Do not drive while wearing this splint. It stops you from gripping the wheel safely. You can drive once the splint is removed and your surgeon clears you. See our guide on driving after upper-limb surgery for more details.
At home, you will do gentle hand exercises. We work with Ruby Doolan at Extend Rehabilitation for your hand therapy. She will teach you movements to restore flexibility. You will use your hand for light tasks as comfort allows. Avoid heavy lifting or forceful gripping until your surgeon says it is safe.
Sleeping may feel different at first. Try to keep your operated hand supported on a pillow. This prevents awkward positions that cause pain. As swelling settles, you will notice more movement. Your timeline may differ; your surgeon and hand therapist 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 that did not work, a second surgery to remove the trapezium bone is an option. This procedure, known as a secondary trapeziectomy, generally provides results similar to the first surgery. You can expect a significant and lasting improvement in how your hand functions. However, it is not always clear how much of this improvement comes directly from the operation itself versus other factors.
Some patients choose a simpler version of the surgery where the bone is removed without adding extra tendon support. This simple approach may lead to fewer complications compared to more complex versions that involve ligament reconstruction and tendon interposition. In those more complex cases, you might notice reduced pain in about 80% of patients over a twelve-month period. While this is effective, it is important to know that complications can still occur even when the surgery is planned carefully and performed with precision.
In some cases, a small implant may be used alongside the bone removal. If this implant causes no issues, it can provide good short-term results. However, if complications arise with the implant, they need to be addressed. You might feel discomfort or notice changes in your hand’s movement. If you experience sudden swelling, increased pain that does not ease with medication, or signs of infection like spreading redness or warmth around the wound, contact the clinic immediately. These could be signs that require urgent attention.
For women over forty with wear-and-tear arthritis in the thumb joint, choosing this bone removal procedure over fusing the joint may result in fewer moderate or severe complications. This means you might face a lower risk of significant issues compared to the alternative fusion option. Still, every body reacts differently. If you notice any unusual symptoms, such as a clicking sensation, persistent numbness, or difficulty gripping objects, bring it up at your next review. Do not wait for your scheduled appointment if symptoms worsen suddenly.
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. Go to emergency if you experience sudden severe pain, calf swelling, shortness of breath, loss of sensation, or inability to move your limb. These symptoms need urgent assessment. We are here to help you stay safe during your recovery.
Where to read more
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Basal Thumb Arthritis page.
Where to read more
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Basal Thumb Arthritis page.
