Osteoarthritis of the thumb trapeziometacarpal joint

SummaryTrapeziometacarpal osteoarthritis is a very common condition, with radiological changes prevalent in 30% of post-menopausal women but a large number being asymptomatic. A lack of bony constraints and laxity of the supporting ligaments, particularly the “beak” ligament is consistently implicated in disease progression. The severity can be staged according to the radiological appearance, which does provides a conceptual framework for rationale of treatment. Fortunately, roles for both conservative and surgical options currently exist to successfully treat joint pain and restore joint stability. The surgical options range from ligament reconstruction or osteotomy for early painful laxity, through to trapeziectomy, arthrodesis and arthroplasty for more severe osteoarthritis. The success of ligament reconstruction tendon interposition arthroplasty in treating trapeziometacarpal arthritis has withstood the test of time. Trapeziometacarpal joint replacement ranges from elastomeric spacers and true total joint replacement to the more current hemiarthroplasty designs with varying results. A better understanding of surgical outcomes for advanced arthritis requires long-term prospective outcome studies while the pursuit for an ideal trapeziometacarpal arthroplasty continues.