Trapeziectomy: Everything You Need to Know

A trapeziectomy is a surgical procedure in which the trapezium, one of the carpal bones of the wrist that forms part of the thumb joint, is removed to help manage symptoms of thumb arthritis. Most patients experience an improvement in their arthritis symptoms after a trapeziectomy, including decreased pain and improved use of their thumb for gripping, pinching, and grasping.

Thumb arthritis, also known as carpometacarpal joint osteoarthritis, affects approximately one in three women and one in eight men. When symptoms do not resolve with conservative methods, a trapeziectomy may be recommended to decrease pain and improve hand use and function.

What Is a Trapeziectomy?

A trapeziectomy is a surgical procedure in which the trapezium bone, one of the carpal bones of the wrist, is removed from the hand. A tendon graft or implant, made from silicone or metal, may be used to fill in the missing space.

Thumb arthritis occurs at the carpometacarpal (CMC) joint of the thumb between the metacarpal bone and the trapezium. The shearing forces transmitted through the joint during gripping, pinching, and grasping movements and the decreased strength of supporting ligaments that occur with aging often cause degeneration of the thumb joint over time. Because the thumb is a very mobile joint, it lacks the stability to withstand repetitive stress and easily wears down over time.

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is one of the most common procedures for treating thumb arthritis to obtain long-term stability of the thumb joint.

Potential Risks

Most people recover well after undergoing a trapeziectomy. Potential risks associated with the operation include:

• Infection
• Bleeding and blood clots
• Nerve damage
• Hand scarring
• Remaining or returning symptoms
• Complex Regional Pain Syndrome

If an LTRI procedure is performed, additional risks include:

• Tendon tethering: Tendons that are used for grafting in LTRI procedures can tether, where a tendon develops scarring and adhesions, causing it to stick to its tendon sheath which prevents it from gliding smoothly and functioning properly
• Subsidence: With joint implants, the body can produce an inflammatory reaction in response to the new foreign substance, causing the implant to gradually sink down into surrounding bones

Consult with your healthcare provider about the possible risks of a trapeziectomy to determine if it is an appropriate option for you given your age, current health status, and medical history.

Purpose of a Trapeziectomy

A trapeziectomy is commonly performed for arthritis of the thumb that does not improve with conservative treatment options, including:

• Activity modification: Resting and avoiding painful activities, especially repetitive gripping, grasping, and pinching, can reduce inflammation in the thumb to promote recovery
• Adaptive equipment: Using special tools to help with tasks like opening jars and using utensils can help reduce strain and inflammation of the thumb joint
• Medications: Anti-inflammatory and pain-relieving medications are often prescribed to help manage symptoms
• Cortisone injections: A healthcare provider may inject cortisone into your thumb to locally decrease pain and inflammation
• Bracing or splinting: A thumb brace or splint can be used to externally support the thumb joint to decrease thumb strain while using your hands to complete everyday activities
• Physical or occupational therapy: Physical or occupational therapy can help strengthen the hand and wrist muscles to support the carpometacarpal joint of the thumb to improve hand use and function. Treatment modalities can also be applied to help with pain relief

How to Prepare

The surgical team will provide you with more detailed instructions on what you will need to do in the days and hours before your surgery. It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation to promote optimal healing and a smooth recovery.

You may need to stop taking certain medications in the days leading up to the surgery to prevent excess bleeding or interaction with anesthesia during the operation. Always consult with your healthcare provider about all prescriptions, over-the-counter medications, and supplements that you are taking for your safety.

A trapeziectomy is often performed as an outpatient surgical procedure at either a hospital or outpatient surgical center. You will likely go home the same day of your operation and will not have to stay overnight in the hospital. You will not be allowed to drive to or from the hospital before or after your surgery, so make sure to make arrangements for a friend or family member to provide transportation for you.

Minimizing stress and prioritizing good mental and emotional health are also important to lower levels of inflammation in the body to aid in your recovery. The healthier you go into surgery, the easier your recovery and rehabilitation will be.

What to Expect

Before the Surgery

On the day of your trapeziectomy, you will be taken to a pre-op room where you will be asked to change into a gown. You will undergo a brief physical examination and answer questions about your medical history from the surgical team. 

You will be taken into the operating room equipped with an operating table and several screens, monitors, and medical technology for assessing your status before, during, and after the operation. The surgical team will assist you onto the operating table and you will be given anesthesia medication depending on what type is determined appropriate by your surgeon.

The surgery will either be performed under general anesthesia, where you are asleep during the operation, or local anesthesia, which involves numbing just your arm so that you do not feel anything during the surgery. If you receive general anesthesia, a nurse will place an IV in your arm or hand before you are brought into the operating room.

The skin of your hand and thumb will be sterilized with an antiseptic solution to kill bacteria and prevent infection before an incision is made.

During the Surgery

Your surgeon will make an incision along the top of the metacarpal bone of the thumb and use metal retractors to hold the incision open. The radial nerve and radial artery will carefully be moved out of the way with the retractors to fully expose the underlying bones.

Using a small saw, your surgeon will then make a cross-shaped incision through the trapezium bone to cut it into four quarters. Each of the four pieces of the cut trapezium bone will be removed individually. If there are any bone spurs (bony outgrowth) or loose bodies surrounding the joint, your surgeon will remove them at this time.

If a ligament reconstruction and tendon interposition (LRTI) procedure is performed, a piece of your tendon from one of your wrist flexor muscles, the flexor carpi radialis, will be cut. The tendon will then be surgically reattached to the metacarpal bone of the thumb by drilling a small hole into the metacarpal bone, threading the tendon through, and sewing the tendon to itself to secure it in place. Part of the cut tendon will be used to reconstruct the palmar oblique ligament that connected the metacarpal bone of the thumb to the trapezium.

The remaining portion of the tendon is then folded eight to 10 times, sewn together like an accordion, and inserted into the space where your trapezium was. As you heal, the tendon will toughen into scar tissue and provide added stability to replace the missing bone from the carpometacarpal joint. Sometimes a silicone or metal implant is used instead to replace the removed trapezium.

After the Surgery

After your trapeziectomy, you will be brought to a recovery room where your vital signs will be monitored as the effects of the anesthesia begin to wear off. You will typically be able to go home one or two hours after the operation once you are stabilized.

Recovery

Your thumb will be placed in a cast in order to heal in proper alignment after your trapeziectomy. You will have a follow-up appointment scheduled with your surgeon five to 10 days later. The cast along with your stitches will then be removed between two and four weeks after the surgery, and you will be given a plastic splint. The splint should be worn for four to six weeks. It should be worn at all times, but can be removed when performing specific exercises to strengthen your thumb.

You will be referred to either a physical or occupational therapist who will devise a plan of care and provide you with exercises to restore the range of motion of your thumb and hand. It can take between six and eight weeks to regain full movement in your thumb. You will usually be able to resume driving at this time.

It can take three to six months to increase your strength in order to grab, grip, and pinch without limitations. Most people return to work six to 12 weeks after the operation. It may be up to six months before you can undertake heavy tasks and up to 12 months for the soreness to subside. 

Wound Care

Your surgeon will give you specific instructions on how to wash around your incision site once your cast is removed. Avoid applying lotions, creams, or ointments directly to the area unless specifically instructed to do so by your healthcare provider.

Coping with Recovery

It is important to follow all instructions from your surgeon and physical or occupational therapist to promote optimal healing and recovery for the best possible outcome from a trapeziectomy.

Recommendations for optimal recovery include:

• Prioritizing getting enough sleep at night, at least seven to eight hours, to promote healing
• Eating a healthy diet and managing a healthy weight
• Staying hydrated
• Maintaining a positive attitude and learning how to cope with and manage stress
• Following your exercise program as prescribed by your physical or occupational therapist
• Staying active and limiting the amount of time you spend sitting each day
• Wearing your splint at all times according to your healthcare provider’s instructions, with the exception of removing it to clean the incision and perform your exercises

Long-term Care

Maintaining healthy lifestyle habits to decrease inflammation will promote an ideal healing environment to facilitate your recovery from surgery.

Possible Future Surgeries

A trapeziectomy often has a high success rate for improving symptoms of thumb arthritis. Further surgical procedures are not often performed if symptoms do not improve after the initial operation.

Lifestyle Adjustments

It will take some time before you can regain full use of your thumb and hand after the operation. Make sure that you:

• Elevate your hand when sitting or lying down in the first few weeks after your trapeziectomy to reduce pain and swelling
• Do not push yourself to do too much too soon. Overexerting yourself can increase your pain and delay your recovery. Be careful with using your hand to complete everyday activities and be cautious with lifting, pushing, and pulling
• Attend all of your regularly scheduled therapy sessions as recommended by your healthcare provider, and follow up with a home exercise program

A Word From Verywell

A trapeziectomy is generally an effective way to manage thumb arthritis symptoms. Recovery from a trapeziectomy can vary in length, from several weeks to several months. It is crucial that you follow the appropriate precautions after your operation, including limiting your hand use and wearing your splint and only progressing to more demanding activities when you are cleared by your healthcare provider and physical therapist to do so.