A trapeziectomy is a surgical procedure designed to alleviate the pain caused by advanced basal joint arthritis, also known as carpometacarpal (CMC) joint arthritis, at the base of the thumb. This condition occurs when the cartilage wears away between the first metacarpal bone of the thumb and the trapezium, a small bone in the wrist. The procedure involves removing the trapezium, which eliminates the painful bone-on-bone friction. The resulting space fills with scar tissue, forming a cushion for the thumb metacarpal and improving joint function. This surgery is reserved for cases where non-surgical treatments like splinting, anti-inflammatory drugs, or steroid injections no longer provide adequate relief.
Defining Surgical Success Metrics
The success of a trapeziectomy is primarily measured by significant pain reduction, which is the most important metric. Patients with advanced CMC arthritis often experience severe pain during activities like pinching, gripping, or opening jars. The goal of the surgery is to eliminate or substantially minimize this discomfort, typically quantified using a visual analogue scale (VAS) to rate pain intensity before and after the procedure.
A secondary metric is the improvement in hand functionality and overall Quality of Life (QoL). This is evaluated by measuring the thumb’s range of motion and the ability to perform daily activities, often assessed through questionnaires like the Disabilities of the Arm, Shoulder, and Hand (DASH) score. While objective measurements like grip and pinch strength are recorded, patient-reported outcomes on pain and function are considered the primary indicators of success.
Expected Long-Term Outcomes
Trapeziectomy is considered a highly successful procedure for treating advanced thumb arthritis, especially concerning long-term pain relief. Studies examining outcomes at five years or more post-surgery report a high patient satisfaction rate, typically ranging from 85% to over 95%, with the vast majority reporting excellent or good pain relief. For many patients, the procedure offers permanent alleviation of the chronic, grinding pain that led to the surgery.
In terms of function, the procedure typically provides sufficient functional strength for daily activities, though it may not restore the hand to its original pre-arthritis strength. Long-term follow-up studies show that key pinch strength generally returns to near pre-operative levels, with mild improvement in grip strength after several years. Patients followed for over eight years report only occasional pain during very heavy activities, with low rates of revision surgery needed over extended periods.
Post-Operative Rehabilitation
Post-operative rehabilitation is essential for maximizing the outcome of a trapeziectomy. Immediately following surgery, the thumb and wrist are immobilized in a cast or splint for two to four weeks to protect the surgical site. This initial immobilization is followed by a transition to active range-of-motion exercises to prevent stiffness.
Working with a certified hand therapist is a standard part of the recovery process. The therapist guides the patient through gentle exercises focused on improving mobility, progressing later to strengthening exercises, typically starting around six to eight weeks post-surgery. It can take up to six months for pinch strength to return fully and up to a year for all soreness to subside.
Potential Complications and Risks
While highly successful, a trapeziectomy does carry specific risks that can affect the final outcome. A common concern is the potential for nerve injury, which can cause numbness or a painful sensation near the surgical scar or over the back of the hand between the thumb and index finger. Though often temporary, persistent nerve issues can lead to a less-than-ideal result.
Another specific complication is “pillar pain,” which is discomfort felt on the radial side of the wrist due to the new biomechanical changes after the bone removal. Other general risks associated with any surgery include infection at the surgical site, blood clots, and joint stiffness. In rare cases, Complex Regional Pain Syndrome (CRPS) can develop, causing severe pain, stiffness, and loss of hand function.