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 treatments, a trapeziectomy may be recommended to decrease pain and improve hand use and function.

What Is a Trapeziectomy?

In a trapeziectomy procedure, the trapezium bone is removed and the space is filled with a tendon graft or an implant made from silicone or metal.

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 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, possible complications 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. That 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

When you prepare for surgery, be sure to follow the instructions from your surgical team. In general, before surgery, it's recommended that you:

• Stay active
• Eat a healthy diet
• Stop smoking
• Minimize stress and prioritize good mental health

These steps can all lower pre-surgery inflammation levels and give you the best chance of recovering quickly.

Stopping Medications and Supplements

You may need to take a break from some medications or supplements for a few days before the surgery. That's because some of them can cause heavy bleeding or interact with the anesthesia.

The requirements for this vary by drug, so talk to your healthcare provider about which drugs and supplements you need to stop taking and for how long. This includes prescription and over-the-counter medications as well as any vitamins and herbal products you may use.

If you need to wean off of a medication, follow your healthcare provider's directions.

Arrange for a Ride

A trapeziectomy is often performed as an outpatient surgical procedure, meaning you'll go home the same day. You won't be allowed to drive home after your surgery, so make sure to arrange for a ride.

What to Expect

Certain procedures may vary depending on where your trapeziectomy is done. The information below gives you an idea of how things typically go.

Before the Surgery

When you arrive for your trapezium thumb surgery, you'll be taken to a pre-op room. There, you'll:

• Change into a surgical gown
• Have a brief physical exam
• Answer questions about your medical history

Next, you'll go into the operating room and be moved to the operating table. You'll then be given anesthesia, which will be either:

• General anesthesia, which is given intravenously (into a vein) and makes you sleep
• Local anesthesia, which numbs your arm so you don't feel anything

The skin around the surgery site will be sterilized to prevent infection.

During the Surgery

Trapeziectomy involves multiple steps. The surgeon typically:

• Makes an incision along the top of the metacarpal bone. That's the slender bone between your wrist and the base of your thumb.
• Uses metal retractors to hold open the incision.
• Carefully moves the radial nerve and radial artery out of the way to expose the bones.
• Uses a small saw to cut the trapezium bone into quarters.
• Removes each piece individually.

If there are any bone spurs (bony growths) or loose fragments surrounding the joint, your surgeon will remove those, as well.

If you also need a ligament reconstruction and tendon interposition (LRTI) procedure:

• A piece of tendon from one of your wrist muscles (the flexor carpi radialis) will be cut.
• Part of the cut tendon will be used to reconstruct the ligament that used to connect the metacarpal bone to the trapezium.
• The remaining portion of the tendon is then folded and used to fill the space where your trapezium was.

Sometimes, a silicone or metal implant is used to replace the trapezium.

After the Surgery

After your trapeziectomy, you will be brought to a recovery room. Your vital signs will be monitored as the effects of the anesthesia begin to wear off.

You'll typically be able to go home one or two hours after the procedure.

Recovery

You'll go home with stitches and a cast on your thumb, which will help it heal properly. A typical recovery timeline looks like this:

• 5-10 days post-surgery: Follow-up appointment.
• 2-4 weeks post-surgery: Cast and stitches removed, plastic split provided.
• 4-6 weeks post-surgery: Plastic splint is removed only when washing or doing post-trapeziectomy exercises. Physical or occupational therapy begins.
• 6-8 weeks post-surgery: Splint can be worn only at night. Full movement may be regained and you may be able to drive.
• 6-12 weeks post-surgery: Heavy tasks may be possible. May be able to return to work.
• 12 weeks-6 months post-surgery: Regain the ability to grab, grip, and pinch with restrictions.
• Up to 12 months post-surgery: Some soreness may remain, but it should steadily diminish.
  

Your surgeon will give you specific instructions on how to wash around your incision site once your cast is removed. Don't use lotions, creams, or ointments on the area unless your provider says to.

You can do some things to help your body recover well. They include:

• Getting enough sleep (7-8 hours per night)
• Eating a healthy diet
• Staying hydrated
• Staying active (but not overdoing it)
• Maintaining a positive attitude and managing stress
• Following the exercise program from your physical or occupational therapist
• Wearing your splint according to your healthcare provider’s instructions

It's important to follow all instructions from your healthcare team so you can have the best possible outcome from your trapeziectomy.

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.