Trapeziectomy: Everything You Need to Know

A trapeziectomy is a surgical procedure in which the trapezium, one of the bones of the wrist, is removed to treat symptoms of thumb arthritis. Most people experience an improvement in their arthritis symptoms after a trapeziectomy, including decreased pain and improved use of their thumb for gripping, pinching, and grasping.

This article explains what is involved in a trapeziectomy, including when it is needed, how to prepare, and what to expect during and after surgery.

What Is a Trapeziectomy?

A trapeziectomy is a surgery used to treat trapeziometacarpal osteoarthritis, also known as thumb arthritis. Osteoarthritis is the most common form of arthritis associated with the aging-related degeneration of joints.

During a trapeziectomy, the trapezium bone is removed and the space is filled with a tendon graft or an implant made from silicone or metal. The trapezium is a nugget-shaped bone in the wrist situated immediately beneath the long bone of the thumb, called the metacarpal bone.

Because the thumb is a very mobile joint, it lacks the stability to withstand repetitive stress and wears down easily over time. When this happens, the cartilage in the joint between the trapezium and metacarpal bones will break down and thin. Over time, the underlying bone will start to change and the joint space will narrow, causing pain, stiffness, and swelling.

When these symptoms do not resolve with conservative treatments, a trapeziectomy may be recommended. Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is one of the most common procedures for treating thumb arthritis.

Potential Risks

Most people recover well after a trapeziectomy, but there are potential risks associated with the surgery, including:

• Bleeding
• Blood clots
• Infection
• Hand scarring
• Nerve damage
  
• Continuing symptoms

Speak with your healthcare provider to fully understand the benefits and risks of a trapeziectomy to determine if it is the best treatment option for you.

Purpose of a Trapeziectomy

The primary reason to undergo trapeziectomy is to resolve arthritis pain at the base of the thumb that gets worse with movement or activity.

A trapeziectomy is commonly performed when thumb arthritis does not improve with conservative treatments, including:

• Anti-inflammatory drugs
• Cortisone injections
• Bracing or splinting
• Physical therapy
• Occupational therapy

How to Prepare

A trapeziectomy is often performed as an outpatient procedure, meaning you'll go home the same day. You won't be allowed to drive home after surgery, so be sure to arrange for a ride.

You may also need to take a break from certain drugs or supplements you take several days before surgery as they may promote bleeding or interfere with anesthesia. These include:

• Anticoagulants ("blood thinners"): Typically 3 to 5 days before surgery
• Monoamine oxidase inhibitors (MAOIs): Typically 2 weeks before surgery
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Typically 7 to 10 days before surgery

You will also be instructed to stop eating before midnight on the eve of your surgery. This is to avoid possible vomiting and accidental aspiration while undergoing anesthesia.

Be sure to follow your surgeon's pre-operative instructions to avoid complications or the possible delay of your procedure.

What to Expect

Procedures can vary depending on where your trapeziectomy is performed. The information below gives you a general idea of what to expect.

Before the Surgery

When you arrive for your surgery, you will be taken to a pre-op room where you will:

• Change into a surgical gown.
• Have your vital signs taken.
• Have adhesive probes placed on your chest to monitor your heart rate with an electrocardiogram (ECG) machine.
• Have a sensor called a pulse oximeter placed on your finger to monitor your blood oxygen levels.
• Have an intravenous (IV) line played in a vein in our arm to deliver anesthesia and medications.
• Meet with an anesthesiologist to discuss which type of anesthesia they will use and to double-check for any possible concerns, such as allergies and prior reactions to anesthesia.

You'll then be wheeled on a gurney to the operating table.

During the Surgery

Depending on the severity of your arthritis and other factors, you may undergo general anesthesia (in which you are fully asleep), monitored anesthesia care ("twilight sleep"), or local anesthesia (which numbs the surgical site while you remain awake).

Trapeziectomy involves multiple steps. For a trapeziectomy with LRTI, the surgeon will typically:

1. Make an incision along the top of the metacarpal bone.
2. Use metal retractors to hold open the incision.
3. Carefully move the radial nerve and radial artery aside to expose the trapezium.
4. Uses a small specialized saw to cut the trapezium bone into quarters.
5. Removes each piece individually.
6. Scape and remove any bone spurs from the adjacent joints.
7. Take a piece of tendon from your wrist muscle.
8. Reconstruct the tendon so that it connects the metacarpal bone to the trapezium.
9. Fold and tuck the ends of the tendon so that it fills the space where your trapezium was. Sometimes, a silicone or metal implant is used instead of a tendon from your wrist.

It usually takes 60 to 90 minutes to complete a trapeziectomy.

After the Surgery

After your trapeziectomy, you will be brought to a recovery room. Your vital signs will be monitored as the effects of the anesthesia begin to wear off. You'll typically be able to go home one or two hours after the procedure.

Recovery

After a trapeziectomy, you'll go home with stitches and a cast on your thumb. To help ease pain and inflammation, you'll be prescribed medication like Tylenol (acetaminophen). You can also ice and elevate your hand, especially during the first week.

A typical recovery timeline looks like this:

• 5 to 10 days: You will have a follow-up appointment with your surgeon.
• 2 to 4 weeks: The cast and stitches are removed, and you'll be given a plastic splint to stabilize the wrist. The splint is only removed when washing or doing post-operative wrist exercises.
• 4 to 6 weeks: Physical therapy begins.
• 6 to 8 weeks: The splint can now be worn at night only. Thumb movement should be amply improved by this stage, and you may be able to drive.
• 6 to 12 weeks: Heavy tasks may be possible. You may be able to return to work.
• 12 weeks to 6 months: There should be full recovery with the ability to grab, grip, and pinch (albeit with restrictions in some cases).
  

Your surgeon will give you specific instructions on how to change dressings and wash the incision site once your cast is removed. Do not use lotions, creams, or ointments on the area unless your provider gives you the OK.

Long-Term Care

A trapeziectomy has a high success rate. Additional surgeries are uncommon.

With that said, it may take time before you can regain full use of your thumb and hand. To ensure the best possible outcome, follow these simple, self-care instructions:

• Elevate your hand when sitting or lying down in the first few weeks following your trapeziectomy to reduce pain and swelling.
• Avoid overexerting yourself as this can increase pain and delay recovery. Be careful when using your hand for everyday tasks involving gripping, lifting, pushing, or pulling.
• Keep your recommended medical appointments even if you feel OK. This can help avoid complications or healing problems you may not recognize.

Summary

A trapeziectomy is a surgery used to treat thumb arthritis when conservative treatments fail. It involves removing a bone in the wrist, called the trapezium, and replacing it either with a tendon from your own body or a metal or silicone implant.

Recovery times can vary from several weeks to several months. It is crucial that you follow your healthcare provider's instructions to ensure the best possible results.