Trapeziometacarpal total joint arthroplasty versus trapeziectomy: clinical outcomes, patient experiences and postoperative care
Trapeziometacarpal total joint arthroplasty versus trapeziectomy: clinical outcomes, patient experiences and postoperative care
Osteoarthritis of the thumb base causes pain and loss of strength. The likelihood of developing osteoarthritis increases with age and is twice as common in women as in men. Because the thumb plays an important role in many daily activities, thumb-base osteoarthritis can significantly affect daily functioning and quality of life.
Treatment usually begins with education about osteoarthritis, joint-protection advice, splinting and exercise therapy, possibly supplemented with pain medication or injections. If these measures are insufficient, two common surgical options are available: trapeziectomy (removal of the trapezium bone) and implantation of a joint-replacement prosthesis. Scientific evidence indicating which procedure is preferable is limited: there are few well-designed comparative studies, making it difficult to draw firm conclusions about the best treatment.
Comparison of surgeries
The doctoral research of Elske Bonhof-Jansen shows that both procedures (trapeziectomy and prosthesis) are roughly equally effective after five years in reducing symptoms and improving hand function in patients with grade II–III thumb-base osteoarthritis. There was no clear difference in patient-reported general function, but the prosthesis did show advantages in thumb strength, fine motor skills, and patient satisfaction. Reoperation rates were similar in both groups. For both procedures, pain typically decreases and results are generally satisfactory, despite possible residual symptoms such as pain during heavy use, loss of strength, or limited fine motor skills. The advantage of the prosthesis is faster rehabilitation, but it remains unclear whether the additional costs of a prosthesis outweigh these benefits. Future studies on cost-effectiveness are needed. Further research is also required to determine which primary outcome measure is most suitable for comparing surgical procedures for thumb-base osteoarthritis in clinical trials.
Postoperative care for prostheses
The literature review (Chapter 5) showed that there is no scientific evidence for the optimal postoperative care pathway after implantation of a thumb-base prosthesis. Comparative studies on immobilization protocols and rehabilitation regimes after a prosthesis are lacking. As a result, postoperative approaches vary widely depending on the type of prosthesis and the clinic. Protocols differ substantially and lack strong scientific underpinning. Reporting of complications is also inconsistent and often incomplete.
It has not yet been well studied whether early mobilization is safer or more effective than immobilization. The value of supervised hand therapy was also unclear. The study in Chapter 6 showed that supervised hand therapy after prosthesis implantation offers no clear advantage over good patient education and daily use guided by pain. It appears safe to allow patients to recover independently at home, provided they are well informed. Nevertheless, additional large-scale research is desirable to confirm these conclusions.