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What Is Thumb Carpometacarpal Arthroplasty?

Thumb carpometacarpal arthroplasty is surgery used to treat painful arthritis at the joint between the thumb metacarpal and trapezium. Most procedures remove the trapezium, eliminating the arthritic contact at the base of the thumb. The thumb metacarpal can then be supported with a tendon, suture construct, temporary pin, or another suspension technique. The goal is to reduce pain while preserving useful thumb motion and pinch function.

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What Is Thumb Carpometacarpal Arthroplasty?

Thumb carpometacarpal arthroplasty is surgery used to treat painful arthritis at the joint between the thumb metacarpal and trapezium. Most procedures remove the trapezium, eliminating the arthritic contact at the base of the thumb. The thumb metacarpal can then be supported with a tendon, suture construct, temporary pin, or another suspension technique. The goal is to reduce pain while preserving useful thumb motion and pinch function.

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Why Is Thumb Carpometacarpal Arthroplasty Performed?

The procedure is considered when thumb carpometacarpal arthritis causes persistent pain, weakness, deformity, or difficulty with pinching and grasping despite nonsurgical treatment. Splinting, anti-inflammatory medication, hand therapy, and corticosteroid injections are commonly tried before surgery. X-rays help define the severity and pattern of arthritis and can identify nearby joint disease. The selected procedure depends on symptoms, joint condition, hand demands, and surgeon preference.

How Is Thumb Carpometacarpal Arthroplasty Performed?

The surgeon reaches the base of the thumb through an incision and removes the trapezium in a standard trapeziectomy-based arthroplasty. Different techniques are then used to support the thumb metacarpal and limit painful collapse into the space left by the trapezium. Ligament reconstruction and tendon interposition use a wrist tendon, while other procedures use sutures, suspension devices, or temporary pins. Additional arthritis or thumb-joint problems can be treated during the same operation when needed.

What Is Recovery Like After Thumb Carpometacarpal Arthroplasty?

The thumb and wrist are protected in a splint or cast during the early healing period. Hand therapy then progresses motion, scar care, pinch, and grip strength over time. Light daily activities return before heavy gripping and forceful pinching because strength commonly takes several months to improve. Swelling and soreness at the thumb base can continue even after the incision has healed.

What Are the Risks and Complications?

Possible complications include infection, bleeding, stiffness, numbness, painful scarring, and complex regional pain syndrome. The thumb metacarpal can settle or migrate toward the wrist after the trapezium is removed, and some patients continue to have pain or weakness. Tendon or suspension constructs can fail, stretch, or cause irritation. Persistent symptoms can lead to additional therapy, injections, hardware treatment, or revision surgery.

Frequently Asked Questions About Thumb Carpometacarpal Arthroplasty

Is the trapezium removed during thumb CMC arthroplasty?

Yes, in many common techniques the trapezium is removed. The thumb metacarpal is then supported using one of several suspension or stabilization methods.

What is LRTI in thumb arthritis surgery?

Ligament reconstruction and tendon interposition (LRTI) uses part of a tendon to help suspend the thumb metacarpal and fill or support the space after trapeziectomy.

Does thumb CMC arthroplasty preserve motion?

Yes. Unlike joint fusion, arthroplasty is intended to reduce pain while preserving useful movement at the base of the thumb.

How long does strength take to return after thumb CMC arthroplasty?

Pinch and grip strength improve gradually over several months. Final recovery varies with the procedure, hand demands, rehabilitation, and preoperative joint condition.

References

Thumb Carpometacarpal (CMC) Arthroplasty. OrthoInfo, American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/thumb-carpometacarpal-cmc-arthroplasty/. Date Accessed August 12, 2026.

Thumb arthritis - Diagnosis and treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/thumb-arthritis/diagnosis-treatment/drc-20378344. Date Accessed August 12, 2026.

Thumb Arthritis: Symptoms and Treatment. American Society for Surgery of the Hand. https://www.assh.org/handcare/condition/thumb-arthritis. Date Accessed August 12, 2026.

Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. PubMed. https://pubmed.ncbi.nlm.nih.gov/21193136/. Date Accessed August 12, 2026.

Surgical Management of Thumb Carpometacarpal Osteoarthritis: A Systematic Review of the Literature. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC12147614/. Date Accessed August 12, 2026.