大多角骨切除术 资料 知情同意

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• The value of adding ligament reconstruction and temporary stabilisation of the pseudarthrosis with a Kirschner wire to trapeziectomy remains unproven until further larger studies are performed [1].
• Secondary trapeziectomy after revision of trapeziometacarpal implants provides results comparable with primary trapeziectomy [2].
• Partial trapeziectomy does not provide a proven advantage over total trapeziectomy at 1 year after surgery for Eaton-Littler grade II to III osteoarthritis [3].
• The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results [4].
• Trapeziectomy with an alternative suspension technique shows good patient-reported outcome measures for primary surgery and poor patient-reported outcome measures after secondary surgery [5].
• The outcomes of trapeziectomy variations including excision, tendon interposition, and ligament reconstruction with tendon interposition were similar after a minimum follow-up of 5 years [6].
• Complete trapezoid excision is not recommended in the context of abductor pollicis longus suspensionplasty [8].
• Due to no significant differences in outcomes between partial and complete excision, partial trapezoid excision is preferred by the authors of the long-term outcomes study [9].
• Trapeziectomy combined with a Swanson implant gives better results in the short term if there are no complications of the operation [10].
• Results suggest an advantage of simple trapeziectomy over trapeziectomy with ligament reconstruction and tendon interposition, though further study is warranted [11].
• At 1 year, total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire [20].
• At 1 year, total joint arthroplasty demonstrated a significant advantage over trapeziectomy in strength and range of motion [20].

Anatomy & Pathophysiology

Bony Anatomy & Architecture

• The thumb metacarpal is independent and articulates with the trapezium [35].
• The hand consists of 19 bones, 17 articulations, and 19 muscles situated entirely within the hand [30].
• The thumb ray is the shortest and is clearly separated from the fingers, implanted proximally [30].
• The thumb has a more proximal and lateral position, allowing movement inward and outward from the palm [30].
• The web space of the thumb is the largest and deepest among the hand's web spaces [30].
• The thumb metacarpal base is the attachment site for suture button suspensionplasty devices [42].
• The second metacarpal serves as the distal attachment site for suture button suspensionplasty devices [42].
• Drilling the second metacarpal for suture button placement carries a risk of metacarpal fracture if the drill is placed too far dorsally [42].

Vascular Anatomy

• The "princeps pollicis" artery is the terminal branch of the radial artery [36].
• The "princeps pollicis" artery crosses the first intermetacarpal space and runs along the ulnar side of the first metacarpal bone [36].
• The "princeps pollicis" artery runs along the volar surface of the adductor muscle [36].
• The "princeps pollicis" artery emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint [36].
• The "princeps pollicis" artery divides into two terminal rami, the collateral palmar arteries of the thumb [36].
• The collateral palmar arteries of the thumb run along the digital tunnel symmetrically and are of equal caliber [36].
• The collateral palmar arteries of the thumb head distally to unite in the pulp arcade [36].
• An arcade located deep in the flexor tendon joins the two palmar arteries at the level of the distal metaphysis of the first phalanx [36].
• Vessels originating from the subtendinous arcade irrigate the flexor tendon via "vincula" [36].
• Only 15% of anatomical dissections of the palmar arteries of the thumb fall into the classical "typical" category [36].
• The dorsal arteries of the thumb vascularize the area corresponding to the posterior surface of the first metacarpal and metacarpophalangeal joint [36].
• The posterior area of the thumb is vascularized by two arteries originating from palmar arteries at the level of the first metacarpal [36].
• The ulnar dorso-collateral artery generally stems from the "princeps pollicis" onto the medial border of the neck of the first metacarpal [36].

Biomechanics & Pathophysiology

• Trapeziectomy results in proximal migration of the first metacarpal [44].
• Suture suspensionplasty mitigates proximal migration of the first metacarpal while maintaining normal motion [44].
• Proximal migration of the thumb metacarpal does not appear to influence the functional outcome [45].
• Postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon interposition [56].
• Ligament reconstruction with tendon interposition and suture-only suspension arthroplasty exhibit equivalent thumb metacarpal subsidence over a greater than 6-month postoperative time frame [53].
• Performing a trapeziectomy followed by up to 4 mm of proximal trapezoid resection has a negligible effect upon carpal, specifically lunocapitate and scapholunate, stability [47].
• Suture button suspensionplasty provides improved axial stability after trapeziectomy while not excessively limiting any one motion of the thumb [59].
• The trajectory of a suture button passed from the thumb metacarpal to the second metacarpal minimally affects range of motion and resistance to subsidence following trapeziectomy [42].
• The mechanism of action for suture button suspensionplasty depends more on the proper tensioning of the device than on the trajectory angle or attachment site features [42].
• The position of the bone anchor in the thumb metacarpal base did not affect the range of motion in internal brace suspensionplasty [50].
• Biomechanic analysis found several biomechanic advantages to trapeziometacarpal implants compared with ligament reconstruction with tendon interposition, including reduction in axial and radial displacement and maintenance of the trapezial space [24].
• The decrease in key pinch force following trapeziectomy and flexor carpi radialis suspensionplasty was larger than the relatively small increase in thumb CMC force [46].
• Subsidence occurs in all patients after trapeziectomy with ligament reconstruction and tendon interposition, but the degree of subsidence does not correlate with postoperative symptoms [61].
• Proximal migration most likely does not cause residual or recurrent pain after trapeziectomy [61].
• First ray subsidence is a poor proxy for success in trapeziectomy, with or without suspensionplasty [61].
• There is no consistent evidence that proximal migration of the first metacarpal is associated with continued symptomatology or poor function [61].

Classification

• Trapeziectomy for trapeziometacarpal joint osteoarthritis is classified as a procedure where the value of adding ligament reconstruction and temporary stabilisation of the pseudarthrosis with a Kirschner wire remains unproven until further larger studies are performed [1].
• Secondary trapeziectomy performed after revision of trapeziometacarpal implants provides results comparable with primary trapeziectomy [2].
• Partial trapeziectomy does not provide a proven advantage over total trapeziectomy at 1 year after surgery for Eaton-Littler grade II to III trapeziometacarpal osteoarthritis [3].
• The outcomes of secondary trapeziectomy following failed total trapeziometacarpal joint replacement arthroplasty generally do not differ from the results of primary trapeziectomy [4].
• Trapeziectomy with an alternative suspension technique for carpometacarpal thumb joint osteoarthritis shows good patient-reported outcome measures for primary surgery and poor patient-reported outcome measures after secondary surgery [5].
• A large improvement in pain and function can be expected after trapeziectomy for thumb base osteoarthritis, although it remains unclear how much of this change is attributable to the surgery itself [7].
• Due to no significant differences in outcomes between partial and complete excision, partial trapezoid excision is preferred for APL suspensionplasty [9].
• Degenerative change at the pseudarthrosis after trapeziectomy has been documented at 6-year follow-up [12].
• Arthroscopic hemitrapsiectomy and thermal capsular modification without interposition for stage III thumb carpometacarpal arthritis yields results that last for a minimum of 4 years and are comparable to those reported for open techniques involving complete trapeziectomy [13].
• Complications after trapeziectomy and suspension arthroplasty can occur despite proper preoperative evaluation, meticulous surgical technique, and vigilant postoperative rehabilitation [14].
• Simple trapeziectomy for trapeziometacarpal joint osteoarthritis was first described over 65 years ago [15].
• There is no strong evidence that procedures performed in addition to simple trapeziectomy improve outcomes [15].
• Some procedures performed in addition to simple trapeziectomy have a higher incidence of complications than simple trapeziectomy [15].
• Trapeziectomy and ligament reconstruction tendon interposition is a surgical treatment option for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist [16].
• A survey of US hand surgeons’ preferred method for treating scaphotrapeziotrapezoid osteoarthritis showed that trapeziectomy/ligament reconstruction tendon interposition followed by scaphotrapeziotrapezoid fusion was chosen by half of the respondents [16].
• Long-term follow-up of partial trapeziectomy for trapeziometacarpal joint arthritis demonstrated no symptomatic progression of arthritis at the scaphotrapezial joint [17].
• Partial trapeziectomy maintains ligamentous stability at the scaphotrapezial joint [17].
• Grip strength and pinch strength after partial trapeziectomy were equivalent to the nonoperated hand, excluding patients with bilateral procedures [17].
• Scaphometacarpal arthroplasty is a reliable medium-term solution for revision of the loosening of a trapeziometacarpal prosthesis with trapezial damage and for failed trapeziectomy [21].
• Trapeziectomy remains the reference standard for surgical treatment in Eaton-Littler stage III or IV thumb trapeziometacarpal osteoarthritis [28].
• The concept of combining trapeziectomy with ligament reconstruction and tendon interposition was introduced to improve stability and minimize impingement of the newly formed scaphometacarpal joint [28].
• Studies have demonstrated that ligament reconstruction and tendon interposition improves grip strength, pain, and patient satisfaction [28].
• Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term [62].

Clinical Presentation

• Patients with psychological risk factors experience improved pain and function outcomes following trapeziectomy [43].
• Outcomes for patients with psychological risk factors are significantly worse than patients who do not have psychological risk factors [43].
• A large improvement in pain and function can be expected after trapeziectomy [7].
• It remains unclear how much of the improvement after trapeziectomy is attributable to the surgery itself [7].
• Pain at the base of the thumb in patients older than 50 years is most commonly caused by osteoarthritis of the trapeziometacarpal joint [16].
• Radiographs in some patients with pain at the base of the thumb reveal isolated osteoarthritis of the scaphotrapeziotrapezoid joint [16].
• The incidence of isolated scaphotrapeziotrapezoid osteoarthritis varies between 2% and 24% [16].
• Isolated scaphotrapeziotrapezoid osteoarthritis occurs more frequently combined with trapeziometacarpal joint osteoarthritis [16].
• Thumb metacarpal-trapezoid impingement is a poorly described etiology for pain after trapeziectomy and basal joint soft tissue arthroplasty [49].
• Thumb metacarpal-trapezoid impingement can be diagnosed with the aid of nuclear imaging [49].
• Patients presenting with thumb metacarpal-trapezoid impingement after basal joint arthroplasty had an average age of 62 years [49].
• The average time to presentation for thumb metacarpal-trapezoid impingement after basal joint arthroplasty was 7 months [49].
• Advanced imaging including 25 mCi 99mTc methylene diphosphonate bone scintigraphy and single-photon emission computed tomography shows intense tracer uptake between the base of the thumb metacarpal and residual trapezoid in cases of impingement [49].
• Computed tomography scans confirm abutment between the base of the thumb metacarpal and residual trapezoid in cases of impingement [49].
• In a case series of thumb metacarpal-trapezoid impingement, grip strength improved from a mean of 10.5 to 23 kg after revision surgery [49].
• In a case series of thumb metacarpal-trapezoid impingement, lateral pinch strength improved from a mean of 3 to 6.75 kg after revision surgery [49].
• In a case series of thumb metacarpal-trapezoid impingement, Patient-Rated Wrist Evaluation pain scores improved from 35 to 6 after revision surgery [49].
• In a case series of thumb metacarpal-trapezoid impingement, Patient-Rated Wrist Evaluation function scores improved from 78 to 14 after revision surgery [49].
• In a case series of thumb metacarpal-trapezoid impingement, QuickDisabilities of the Arm, Shoulder, and Hand scores improved from 37 to 18 after revision surgery [49].

Investigations

• The trapezium is clearly 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 [40].
• The articular surfaces of the trapezium and the base of the first metacarpal have a saddle shape in opposing planes [40].
• The thumb metacarpal is the shortest metacarpal [40].
• The first ray is made up of only three bones: a metacarpal and two phalanges [40].
• The first ray continues the external column of the carpus formed by the scaphoid and trapezium [40].
• The scaphotrapezial joint is susceptible to degenerative change after partial trapeziectomy, with an average participant demonstrating stage 1 disease (minimal narrowing on the radiograph) at an average 9-year follow-up [17].
• There was no symptomatic progression of arthritis at the scaphotrapezial joint after partial trapeziectomy in patients with no preoperative symptoms of scaphotrapezial joint arthritis [17].
• The radiographic presence of scaphotrapezoidal arthritis does not correlate with the patient's main symptoms after partial trapeziectomy [69].

Treatment

Operative Technique and Variations

• Trapeziectomy is performed via a dorsoradial incision, involving release of the first extensor compartment and passing a distally based strip of the abductor pollicis longus (APL) through a slit in the flexor carpi radialis to form a suspensory support [27].
• The trapezium is removed through a dorsal approach, with the first dorsal compartment released along the dorsal margin of the subsheath to prevent volar tendon subluxation [63].
• The trapezium may be removed piecemeal with a Rongeur or as a whole with a corkscrew joystick, depending on surgeon preference [63].
• A dorsal incision centered over the thumb carpometacarpal joint is used for suture button suspensionplasty, with the surgical plane between the abductor pollicis longus and extensor pollicis brevis tendons [70].
• In suture button suspensionplasty, the trapezium is removed piecemeal to protect the underlying flexor carpi radialis tendon [70].
• Osteophytes around the first and second metacarpal bases are removed during suture button suspensionplasty to prevent impingement when Mini TightRope devices are placed and tied [70].
• A corkscrew found in the Mini-TightRope CMC set is used to gain solid purchase in the trapezium as a joystick for excision of the trapezium as a whole [71].
• A C-ring targeting guide is used routinely in suture button suspensionplasty to ensure the exit point on the second metacarpal is placed at the ulnar surface of the diaphyseal-metaphyseal junction [71].
• A tapered suture-passing guidewire that is 1.1 mm at its widest diameter and tapers to 0.86 mm with a Nitinol loop is used in suture button suspensionplasty [71].
• Wide-awake basal joint trapeziectomy can be performed using only locally injected lidocaine and epinephrine without a tourniquet or sedation [29].
• Outcomes for the anterior approach to trapeziectomy are equally good or better than with the posterior approach [41].
• Arthroscopic hemitrapsiectomy and thermal capsular modification without interposition is a treatment option for stage III thumb carpometacarpal arthritis [13].
• Trapeziectomy and ligament reconstruction tendon interposition (LRTI) is a surgical treatment option for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist [16].
• A mitek anchor inserted into the second metacarpal bone can be used to fix the tendinous graft of the abductor pollicis longus in trapeziectomy and tendon suspension [73].

Outcomes and Efficacy

• Trapeziectomy is a good method of treating osteoarthritis of the thumb base [41].
• The outcomes of trapeziectomy, trapeziectomy with tendon interposition, and trapeziectomy with ligament reconstruction and tendon interposition were similar after a minimum follow-up of 5 years [6].
• Arthroscopic hemitrapsiectomy and thermal capsular modification without interposition results appear to last for a minimum of 4 years and are comparable to those reported for open techniques involving complete trapeziectomy [13].
• Trapeziectomy and LRTI are effective procedures for patients aged less than 56 years [23].
• Over a follow-up period of 12 months, trapeziectomy and LRTI is an effective treatment in significantly reducing pain in 80% of patients [25].
• Trapeziectomy produces better functional results and overall satisfaction than pyrocarbon arthroplasty [26].
• The removal of a pyrocarbon carpometacarpal implant using subsequent trapeziectomy successfully relieves pain in patients in whom pyrocarbon arthroplasty has failed [18].
• A large improvement can be expected after trapeziectomy, although it remains unclear how much of this change is attributable to the surgery itself [7].

Complications and Risks

• Increased complications have been reported in trapeziectomy with ligament reconstruction and tendon interposition compared with trapeziectomy alone [11].
• Index metacarpal fracture has been reported after tightrope suspension following trapeziectomy [19].
• Surgeons should use caution when considering suture button fixation after complete trapeziectomy until more data are available [19].
• Degenerative change at the pseudarthrosis can occur after trapeziectomy [12].

Biomechanics and Adjuncts

• Biomechanic analysis found several advantages to the tie-in trapezium implant compared with LRTI, including reduction in axial and radial displacement and maintenance of the trapezial space [24].
• The value of ligament reconstruction and temporary stabilisation of the pseudarthrosis with a Kirschner wire remains unproven until further larger studies are performed [1].
• Trapeziectomy combined with Swanson implant gives better results in the short term if there are no complications of the operation [10].
• These results suggest an advantage of simple trapeziectomy over trapeziectomy with ligament reconstruction and tendon interposition, however, further study is warranted [11].

Complications

General Complications

• Potential complications of trapeziometacarpal arthroplasty techniques include infection, sensory nerve irritation, radial artery injury, injury to the flexor carpi radialis tendon during bone removal, and postoperative subsidence with weakness and recurrence of pain [60].
• Persistent post-operative pain following trapeziectomy can be caused by incomplete trapezial resection, neuroma formation due to injury of sensory branches of the radial nerve, unrecognized concomitant arthritis in the scaphotrapezoid joint, metacarpophalangeal arthritis, metacarpal base spurs, instability in the metacarpophalangeal joint, and complex regional pain syndrome [66].
• Persistent post-operative pain following trapeziectomy can be caused by abutment between the metacarpal base and scaphoid due to proximal migration [66].

Nerve and Soft Tissue Complications

• Five patients developed transient superficial radial nerve neuritis that resolved over 3 months following arthroscopic partial trapeziectomy with soft tissue interposition [64].
• Patients should be warned about the potential complication of flexor carpi radialis tendinitis after trapeziectomy and abductor pollicis longus suspensionplasty [77].

Bony Complications

• Index metacarpal fracture after suture button suspensionplasty has been reported [60].
• Surgeons should use caution when considering suture button fixation after complete trapeziectomy until more data are available regarding index metacarpal fracture [19].

Functional and Deformity Complications

• One patient developed a 30-degree hyperextension deformity at the metacarpophalangeal joint requiring metacarpophalangeal joint arthrodesis following arthroscopic partial trapeziectomy with soft tissue interposition [64].
• One patient developed painful instability of the thumb metacarpal base with radial and proximal migration of the thumb metacarpal following arthroscopic partial trapeziectomy with soft tissue interposition [64].

Comparative Complication Rates

• Increased complications were observed in trapeziectomy with ligament reconstruction and tendon interposition compared with trapeziectomy alone [11].
• Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo ligament reconstruction and tendon interposition [80].
• Complications were more frequent following arthrodesis than ligament reconstruction and tendon interposition, although most did not affect the overall outcome [79].
• Results for a large series of suture button suspension for carpometacarpal arthroplasty with intermediate follow-up revealed low complication rates [78].

Recovery

• 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 [54].
• Over a follow-up period of 12 months, trapeziectomy and ligament reconstruction and tendon interposition (LRTI) is an effective treatment in significantly reducing pain in 80% of patients [25].

Key Evidence

• [L1] Until further larger studies are performed, the value of such additions to trapeziectomy remains unproven. [1] (10.1177/1753193408098483)
• [L3] Secondary trapeziectomy after revision of trapeziometacarpal implants provides results comparable with primary trapeziectomy. [2] (10.1177/17531934211039184)
• [L2] We cannot conclude that partial trapeziectomy provides an advantage over total trapeziectomy at 1 year after surgery. [3] (10.1016/j.jhsg.2020.03.004)
• [L3] The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results. [4] (10.1016/j.jhsa.2013.01.030)
• [L4] Trapeziectomy with this alternative suspension technique for treatment of carpometacarpal thumb joint osteoarthritis shows good patient-reported outcome measures for primary surgery and poor patient-reported outcome measures after the secondary surgery. [5] (10.1016/j.jhsg.2022.02.006)
• [L1] The outcomes of these 3 variations of trapeziectomy were similar after a minimum follow-up of 5 years. [6] (10.1016/j.jhsa.2011.11.027)
• [L2] In contrast, a large improvement can be expected after trapeziectomy, although it remains unclear how much of this change is attributable to the surgery itself. [7] (10.1016/j.jhsg.2025.100741)
• [L4] Complete trapezoid excision is not recommended. [8] (10.1016/j.jhsa.2019.10.006)
• [L4] Due to no significant differences in outcomes between partial and complete excision, the authors now prefer partial trapezoid excision. [9] (10.1016/j.jhsa.2017.06.062)
• [L3] Trapeziectomy combined with Swanson implant gives better results in the short term if there are no complications of the operation. [10] (10.1054/jhsb.1999.0156)
• [L3] These results suggest an advantage of simple trapeziectomy; however, further study is warranted. [11] (10.1177/1558944715617215)
• [L2] [12] (10.1007/s11999-013-2956-0)
• [L4] These results appear to last for a minimum of 4 years and are comparable to those reported for open techniques involving complete trapeziectomy. [13] (10.1016/j.jhsa.2009.12.022)
• [L4] Complications after trapeziectomy and suspension arthroplasty can occur despite proper preoperative evaluation, meticulous surgical technique, and vigilant postoperative rehabilitation. [14] (10.1016/j.jhsa.2013.07.018)
• [L4] [15] (10.1177/1753193418780898)
• [L4] [16] (10.1177/1753193413514500)
• [L4] [17] (10.1016/j.jhsa.2012.02.007)
• [L3] The removal of a pyrocarbon carpometacarpal implant using subsequent trapeziectomy successfully relieves pain in patients in whom pyrocarbon arthroplasty has failed. [18] (10.1016/j.jhsa.2022.01.004)
• [Case_report] Surgeons should use caution when considering suture button fixation after complete trapeziectomy until more data are available. [19] (10.1016/j.jhsa.2011.12.017)
• [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. [20] (10.1177/17531934231185245)
• [L4] Scaphometacarpal arthroplasty is a reliable medium-term solution for revision of the loosening of a trapeziometacarpal prosthesis with trapezial damage and for failed trapeziectomy. [21] (10.1177/1753193419900470)
• [L4] Trapeziectomy and LRTI are effective procedures for patients aged less than 56 years. [23] (10.1016/j.jhsa.2024.07.024)
• [L5] The study found several biomechanic advantages to the implant compared with LRTI, including reduction in axial and radial displacement and maintenance of the trapezial space. [24] (10.1016/j.jhsa.2007.02.025)
• [L2] Over a follow-up period of 12 months, trapeziectomy and LRTI is an effective treatment in significantly reducing pain in 80% of patients. [25] (10.1016/j.jhsa.2021.04.036)
• [L3] Trapeziectomy produces better functional results and overall satisfaction than pyrocarbon arthroplasty. [26] (10.1177/1753193411433176)
• [L4] [27] (10.1097/corr.0000000000001795)
• [L4] [28] (10.1177/1753193419843850)
• [L4] The paper presents a video detailing the technique for wide-awake basal joint trapeziectomy using only locally injected lidocaine and epinephrine without a tourniquet or sedation. [29] (10.1007/s11552-011-9367-z)
• [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. [41] (10.1177/1753193407087571)
• [L5] [42] (10.1007/s11552-012-9473-6)
• [L2] Brief psychological screening shows that patients with psychological risk factors experience improved pain and function outcomes following trapeziectomy, however their outcomes are significantly worse than patients who do not have psychological risk factors. [43] (10.1177/17589983221120839)
• [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. [44] (10.1016/j.jhsa.2022.05.001)
• [L1] Furthermore, proximal migration of the thumb metacarpal does not appear to influence the functional outcome. [45] (10.2106/jbjs.d.02630)
• [L5] The decrease in key pinch force was larger than the relatively small increase in thumb CMC force. [46] (10.1016/j.jhsa.2022.11.018)
• [L5] This biomechanical cadaveric study shows that performing a trapeziectomy followed by up to 4 mm of proximal trapezoid resection has a negligible effect upon carpal, specifically lunocapitate and scapholunate, stability. [47] (10.1016/j.jhsa.2019.06.015)
• [L4] [49] (10.1016/j.jhsa.2021.02.017)
• [L5] The position of the bone anchor in the thumb metacarpal base did not affect the range of motion. [50] (10.1016/j.jhsa.2022.08.001)
• [L3] LRTI and SSA exhibit equivalent thumb metacarpal subsidence over a greater than 6-month postoperative time frame. [53] (10.1177/15589447221084014)
• [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. [54] (10.1016/j.jhsa.2021.08.015)
• [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. [56] (10.1177/1753193415616959)
• [L5] Both TightRope constructs provided improved axial stability after trapeziectomy while not excessively limiting any one motion of the thumb. [59] (10.1177/1558944720906551)
• [L4] [60] (10.1016/j.jhsa.2014.09.012)
• [L5] [61] (10.1177/17531934231186495)
• [L3] [62] (10.1186/s13018-021-02856-x)
• [L3] [63] (10.1177/1558944720906565)
• [L4] [64] (10.1016/j.jhsa.2017.10.016)
• [L4] [66] (10.1177/1753193412447496)
• [L4] The study cannot demonstrate that the radiographic presence of scaphotrapezoidal arthritis correlates with the patient's main symptoms after partial trapeziectomy. [69] (10.1016/j.jhsg.2020.06.005)
• [L4] [70] (10.1016/j.jhsa.2014.10.057)
• [L4] [71] (10.1016/j.jhsa.2017.03.011)
• [L3] [73] (10.1177/1753193412439678)
• [L4] Patients should be warned about this potential complication. [77] (10.1177/1753193413506150)
• [L4] Results for a large series of SBS for CMC arthroplasty with intermediate follow-up revealed excellent clinical outcomes and low complication rates. [78] (10.1016/j.jhsg.2019.11.002)
• [L3] Although complications were more frequent following arthrodesis, most did not affect the overall outcome. [79] (10.2106/00004623-200110000-00002)
• [L1] Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. [80] (10.1016/j.jhsa.2024.10.018)

References

[1] Trapeziectomy for Trapeziometacarpal Joint Osteoarthritis: Is Ligament Reconstruction and Temporary Stabilisation of the Pseudarthrosis with a Kirschner Wire Important?. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408098483

[2] Outcomes of secondary trapeziectomy after revision of trapeziometacarpal implants: a retrospective comparative matched study. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211039184

[3] Partial Versus Total Trapeziectomy With Interposition Arthroplasty for Trapeziometacarpal Osteoarthritis Grade II to III Eaton-Littler: A Clinical Trial. Journal of Hand Surgery Global Online. 2020. DOI: 10.1016/j.jhsg.2020.03.004

[4] 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

[5] Trapeziectomy and Alternative Suspension Technique in Thumb Carpometacarpal Arthritis: Patient-Reported Outcome Measures. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.02.006

[6] Five- to 18-Year Follow-Up for Treatment of Trapeziometacarpal Osteoarthritis: A Prospective Comparison of Excision, Tendon Interposition, and Ligament Reconstruction and Tendon Interposition. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.11.027

[7] Orthosis Followed by Trapeziectomy for Thumb Base Osteoarthritis: A Cohort Pilot Study on Pain and Function. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100741

[8] Effect of Partial and Complete Trapezoid Excision on Radiographic and Functional Results After Abductor Pollicis Longus Suspensionplasty. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.10.006

[9] Long-term Outcomes of APL Suspensionplasty with No, Partial, or Complete Trapezoid Excision. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.062

[10] A Patient-Reported Comparison of Trapeziectomy with Swanson Silastic Implant or Sling Ligament Reconstruction. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0156

[11] Increased Complications in Trapeziectomy With Ligament Reconstruction and Tendon Interposition Compared With Trapeziectomy Alone. HAND. 2016. DOI: 10.1177/1558944715617215

[12] Degenerative Change at the Pseudarthrosis After Trapeziectomy at 6-year Followup. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-013-2956-0

[13] Prospective Outcomes of Stage III Thumb Carpometacarpal Arthritis Treated With Arthroscopic Hemitrapeziectomy and Thermal Capsular Modification Without Interposition. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.12.022

[14] Complications of Trapeziectomy With or Without Suspension Arthroplasty. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.07.018

[15] The long-term outcome of simple trapeziectomy. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418780898

[16] Trapeziectomy and ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413514500

[17] The Scaphotrapezial Joint After Partial Trapeziectomy for Trapeziometacarpal Joint Arthritis: Long-term Follow-up. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.007

[18] Outcomes of Secondary Trapeziectomy Following Carpometacarpal Pyrocarbon Prosthetic Arthroplasty. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.01.004

[19] Index Metacarpal Fracture After Tightrope Suspension Following Trapeziectomy: Case Report. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.017

[20] 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

[21] Scaphometacarpal arthroplasty: a report of ten cases of trapeziometacarpal prosthesis and trapeziectomy revision. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193419900470

[23] Outcome of Trapeziectomy and Ligament Reconstruction and Tendon Interposition for Patients Aged Less Than 56 Years: A Retrospective Study With a Minimum 5-Year Follow-Up. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.07.024

[24] Biomechanic Analysis of Trapeziectomy, Ligament Reconstruction With Tendon Interposition, and Tie-In Trapezium Implant Arthroplasty for Thumb Carpometacarpal Arthritis: A Cadaver Study. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.02.025

[25] Functional Recovery Following Trapeziectomy and Ligament Reconstruction and Tendon Interposition: A Prospective Longitudinal Study. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.04.036

[26] Thumb carpometacarpal osteoarthritis: trapeziectomy versus pyrocarbon interposition implant (Pi2) arthroplasty. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193411433176

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[28] A health utility assessment of trapeziectomy with ligament reconstruction and tendon interposition for thumb trapeziometacarpal osteoarthritis. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419843850

[29] Wide-Awake Trapeziectomy: Video Detailing Local Anesthetic Injection and Surgery. HAND. 2011. DOI: 10.1007/s11552-011-9367-z

[30] Exam Of The Hand Wrist 2Ed. INTRODUCTION.

[35] Exam Of The Hand Wrist 2Ed. The arches of the hand > The metacarpal arch.

[36] Exam Of The Hand Wrist 2Ed. Techniques of investigation of the arterial supply by J P Melki > Vascularization of the thumb > Palmar aspect.

[40] Exam Of The Hand Wrist 2Ed. 1.1 SKELETON OF THE HAND > The osseous skeleton.

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[42] Suture Button Suspension following Trapeziectomy in a Cadaver Model. HAND. 2012. DOI: 10.1007/s11552-012-9473-6

[43] Brief psychological screening for trapeziectomy: Identifying patients at high risk of a poor functional outcome. Hand Therapy. 2022. DOI: 10.1177/17589983221120839

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[46] The Effect of Thumb Metacarpophalangeal Hyperextension on Thumb Axial Load and Lateral Pinch Force in a Cadaver Model of Thumb Trapeziectomy and Flexor Carpi Radialis Suspensionplasty. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.11.018

[47] The Biomechanical Consequences of Trapeziectomy and Partial Trapezoidectomy in the Treatment of Thumb Carpometacarpal and Scaphotrapeziotrapezoid Arthritis. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.06.015

[49] Thumb Metacarpal-Trapezoid Impingement as an Etiology of Pain After Trapeziectomy and Basal Joint Soft Tissue Arthroplasty: A Case Series. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.02.017

[50] Optimal Position of the Bone Anchor for the Internal Brace Suspensionplasty Technique for Thumb Basal Joint Arthroplasty. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.08.001

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[54] Comparison of 2 Postoperative Therapy Regimens After Trapeziectomy Due to Osteoarthritis: A Randomized, Controlled Trial. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.08.015

[56] 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

[59] Optimal Position of the Suture Button Suspensionplasty (TightRope) for Thumb Basal Joint Arthritis. HAND. 2020. DOI: 10.1177/1558944720906551

[60] Double Tightrope for Basilar Thumb Arthritis. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.09.012

[61] Biomechanical analysis of three techniques of suspensionplasty after trapeziectomy: a cadaveric study. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231186495

[62] Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02856-x

[63] Efficacy of Abductor Pollicis Longus Suspensionplasty Compared to Ligament Reconstruction and Tendon Interposition. HAND. 2020. DOI: 10.1177/1558944720906565

[64] Arthroscopic Partial Trapeziectomy With Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis: 6-Month and 5-Year Minimum Follow-Up. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.10.016

[66] The use of Swanson silastic interposition arthroplasty in revision thumb-base surgery for failed trapeziectomy; a case series of 10 patients. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412447496

[69] Long-Term Evaluation Following Partial Trapeziectomy and Suspension Arthroplasty for Trapeziometacarpal Osteoarthritis: An Observational Study. Journal of Hand Surgery Global Online. 2020. DOI: 10.1016/j.jhsg.2020.06.005

[70] Dual Mini TightRope Suspensionplasty for Thumb Basilar Joint Arthritis: A Case Series. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.10.057

[71] Mean 5-Year Follow-up for Suture Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Joint Osteoarthritis. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.03.011

[73] Trapeziectomy and tendon suspension with or without a Mitek anchor fixation in the thumb basal joint osteoarthritis. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412439678

[77] High incidence and treatment of flexor carpi radialis tendinitis after trapeziectomy and abductor pollicis longus suspensionplasty for basal joint arthritis. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413506150

[78] Suture Button Suspensionplasty in the Treatment of Carpometacarpal Arthritis: A Retrospective Analysis of One Surgeon’s Experience Over 9 Years. Journal of Hand Surgery Global Online. 2020. DOI: 10.1016/j.jhsg.2019.11.002

[79] Thumb Carpometacarpal Osteoarthritis: Arthrodesis Compared with Ligament Reconstruction and Tendon Interposition. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200110000-00002

[80] Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A Systematic Review and Meta-Analysis. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.10.018