Surgical Management of Thumb Carpometacarpal Arthritis

Osteoarthritis of the thumb carpometacarpal (CMC) joint is a prevalent source of pain and disability, particularly in post-menopausal women and manual workers. When non-surgical measures such as splintage, anti-inflammatory medication and physiotherapy prove insufficient, a range of surgical interventions is available. The traditional gold standard is trapeziectomy—excision of the trapezium bone—often combined with ligament reconstruction and tendon interposition (LRTI) to stabilise the first metacarpal and prevent proximal migration. Alternative techniques include total joint arthroplasty with prosthetic implants, arthrodesis (fusion) to eliminate movement and, more recently, minimally invasive or arthroscopic approaches that preserve soft tissues. Choice of procedure is informed by patient age, activity level, disease stage and surgeon expertise. Advances in implant design, biomechanical evaluation and pre-operative staging aim to optimise pain relief, preserve thumb motion and minimise complications, while registry data confirm substantial health-related quality of life gains across surgical methods.

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Surgical Management of Thumb Carpometacarpal Arthritis publication trend

The graph below shows the total number of articles in surgical management of thumb carpometacarpal arthritis across all publications each year (not limited to Nature Index journals).

Technical terms

Carpometacarpal (CMC) joint: The articulation between the first metacarpal and the trapezium at the base of the thumb.

Trapeziectomy: Surgical removal of the trapezium bone to relieve CMC joint pain.

Ligament reconstruction and tendon interposition (LRTI): A technique combining tendon grafting and ligament repair to stabilise the metacarpal after trapeziectomy.

Arthroplasty: Joint resurfacing or replacement with a prosthetic implant to preserve motion.

Arthrodesis: Fusion of joint surfaces to eliminate movement and pain.

Eaton–Littler classification: Radiological staging system for thumb CMC osteoarthritis severity.

Outerbridge classification: Arthroscopic grading scale for cartilage damage.

References

1. Comparing Isolated Thumb Force Generation, Wrist Rotation, and Clinical Measurements in Healthy and Osteoarthritic Individuals before and after Surgery. Bioengineering (2024).
2. Assessing the Predictive Accuracy of the Eaton–Littler Classification in Thumb Carpometacarpal Osteoarthritis: A Comparative Analysis with the Outerbridge Classification in a Cohort of 51 Cases. Diagnostics (2024).
3. Trapeziectomy versus joint replacement for first carpometacarpal (CMC 1) joint osteoarthritis: a systematic review and meta-analysis. European Journal of Orthopaedic Surgery & Traumatology (2021).
4. Basal thumb osteoarthritis surgery improves health state utility irrespective of technique: a study of UK Hand Registry data. Journal of Hand Surgery (European Volume) (2020).