Trapezial Resection Arthroplasty: More Is Not Necessarily Better

Introduction: Thumb carpometacarpal joint arthritis can cause significant pain and limitation in activity. Patients who are unable to obtain symptomatic relief from anti-inflammatories, splinting, and cortisone injections may be indicated for surgical treatment. The earliest form of surgical intervention was trapeziectomy alone; since, numerous adjunctive procedures have evolved. In this study, we conduct a literature review comparing outcomes of simple trapeziectomy to other interventions for thumb carpometacarpal arthritis. Methods: A literature search using the PubMed/Medline database was conducted. Inclusion criteria were the following: 1) the study was a primary study written in English, 2) treatment options were surgical and compared trapeziectomy with other forms of surgical treatment for thumb carpometacarpal arthritis, 3) the study was a randomized controlled trial, 4) the study included outcomes such as pain, physical function, range of motion, and/or strength. Included studies were then compiled into a table for further review. Results: 11 studies met inclusion criteria. All studies were randomized controlled trials and demonstrated level II evidence. Surgical procedures in these studies included ligament reconstruction and tendon interposition (LRTI), flexor carpi radialis suspension, carpometacarpal joint denervation, and carpometacarpal joint arthroplasty. No significant differences were found between trapeziectomy alone versus adjunctive surgical procedures when comparing patient-reported outcomes, patient satisfaction, range of motion, grip strength, and key/tip pinch strength with follow-up ranging from 1 year to 18 years post-operative. Discussion/Conclusions: In our review of the evidence, we find no significant differences in patient-reported outcomes, patient satisfaction, range of motion, grip strength, and key/tip pinch strength both in the short- and long-term post-operative periods. This raises the question of whether adjunctive procedures are necessary for the treatment of thumb carpometacarpal arthritis, as they may lead to increased operative time, costs, and complications compared to trapeziectomy alone.