Is there a role for silicone trapezial replacement in the rheumatoid hand?

Destruction of the T-MC joint can be treated by arthrodesis or arthroplasty. Arthrodesis is not recommended because it requires a long period of immobilization, which is not well tolerated by the rheumatoid patient. Furthermore, it will increase the forces at the metacarpophalangeal and interphalangeal joints, increasing their deformities. Trapezoidectomy, with or without tendon interposition and ligament reconstruction, is usually recommended but may cause some basal thumb instability and prolonged postoperative discomfort. Replacement of the trapezium with a silicone implant restores length to the thumb ray, and postoperative recovery is much shorter. The main complication is implant dislocation, which can be prevented if the following is done: use the smallest size implant, create a concavity on the trapezoid bone and stabilize the implant with a slip of the flexor carpi radialis tendon carefully sutured to the distal scaphoid capsule. Transfixing the body of the implant with a Kirschner wire ensures implant stabilization during capsular healing and allows immediate postoperative mobility of the thumb.