Trapeziectomy

Indications

  • Painful thumb base arthritis, Eaton stages II to IV, failing splints and injection
  • Involvement of the scaphotrapeziotrapezoid joint favours trapeziectomy over fusion or replacement
  • Older and low demand patients

Position

  • Supine, arm table, tourniquet
  • Image intensifier to confirm complete excision

Operative Steps

  1. Dorsoradial approach between APL and EPB, or a volar Wagner approach
  2. Protect superficial radial nerve branches and the radial artery in the snuffbox
  3. Remove the trapezium piecemeal, protecting FCR beneath it
  4. Optional ligament reconstruction and tendon interposition with a slip of FCR
  5. Trapeziectomy alone gives similar results to added LRTI with fewer complications (Cochrane review)
  6. Open the capsule longitudinally and preserve it for closure
  7. Check for and remove any trapezoid osteophytes
  8. Consider suspensionplasty with suture button for metacarpal subsidence
  9. Close the capsule over the space

Postoperative Care

  • Thumb spica for about 4 weeks, then therapy
  • Begin gentle motion and pinch strengthening at 4 to 6 weeks
  • Pinch strength recovers over 6 to 12 months
  • Return to heavy work at about 3 months

Complications

  • Superficial radial nerve neuroma
  • CRPS
  • Weakness and subsidence of the metacarpal
  • FCR tendon injury
  • Persistent pain from STT arthritis
  • MCP hyperextension deformity, which should be corrected if over 30 degrees

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.