When basal joint arthritis reaches an advanced stage, daily discomfort may become such that surgery is considered.

Among the most common solutions, two techniques stand out: trapeziectomy and fitting a trapeziometacarpal or TMC prosthesis.

Both have the same aim: to relieve pain, restore mobility and preserve thumb function. However, they differ in principle, post-operative course and indications.

This page is a continuation of the ‘Treatment and care’ section, linked to the ‘Basal joint arthritis’ page.

TMC prosthesis: preserving movement and strength

The trapeziometacarpal prosthesis replaces the worn joint between the trapezium and the first metacarpal with an implant, with the aim of restoring near-natural movements.

This technique is particularly suitable for patients who are still active and whose activities require good mobility and some grip strength.

Pros:

  • Faster recovery, generally returning to everyday activities earlier than after a trapeziectomy.

  • Better thumb strength and mobility.

  • Aesthetically discreet, with no visible shortening.

  • Reversible solution, leaving open the possibility of further interventions in the event of wear or failure.

Good to know :

  • The prosthesis is expected to last between 10 and 15 years.

  • It may be contraindicated in cases of significant deformation of the trapezium bone or damage to the STT (scaphotrapeziotrapezoid) joint.

  • Regular follow-ups are recommended to ensure that the implant is correctly positioned.

For more details: TMC prosthesis: how it works and results

Trapeziectomy: a tried-and-tested solution

A trapeziectomy involves removing the trapezium, the worn bone responsible for the pain.

It may be complemented by tendon interposition or ligamentoplasty to stabilise the joint.

This is a well-known surgical technique that is still widely used, particularly when a prosthesis is not an option.

Pros:

  • Very good long-term clinical data spanning several decades.

  • Low risk of mechanical complications.

  • No risk of implant wear, so potentially a permanent solution.

Possible limitations:

  • Longer recovery time, with several weeks or even months of rehabilitation.

  • Slight loss of strength in some cases, especially in the case of pincer movements.

  • The appearance of the thumb is sometimes altered by progressive sinking.

This solution is often proposed for people with less demanding functional requirements, or when the condition of the joint makes a prosthesis unsuitable.

A choice guided by the profile of each patient

There is no single rule for choosing between a trapeziectomy and prosthesis.

It is determined by several factors assessed during the surgical consultation:

  • Degree of discomfort in daily life.

  • Stage of basal joint arthritis visible on X-ray or CT scan.

  • Bone quality, shape of the trapezium and condition of the STT joint.

  • Professional or manual activity, personal expectations.

  • Any previous history of treatment.

When an operation becomes necessary, the ‘Basal joint arthritis surgery: when should you consult a specialist?’ page can help you identify the right time to review your situation with a specialist.

Two techniques, one goal: regaining comfortable use of the hand

Trapeziectomy or prosthesis: the key is to adapt the technique to the patient, not the other way round. The hand surgeon plays a key role in this decision, explaining:

  • the expected short and long-term benefits

  • any post-operative constraints

  • and possible alternatives in the event of contraindication.

In any case, the operation is part of a progressive care pathway, which begins well in advance with non-surgical solutions:

braces and splints, injections, physiotherapy and home exercises, etc.

To understand post-op follow-up:

Recovery time after thumb surgery

Post-op follow-up and risk of recurrence

Further reading: