Thumb Joint Replacement vs Trapeziectomy for Base of Thumb Arthritis
Comparing the two main operations for arthritis at the base of the thumb.
If base of thumb (CMC) arthritis is no longer controlled with splints, hand therapy or injections, surgery is usually one of two operations: thumb joint replacement or trapeziectomy (sometimes spelt trapezectomy). This page sets out what the published research shows when the two are compared — including studies of patients who have had one operation on each hand.
The two operations explained
Thumb CMC joint replacement
The worn joint surfaces are replaced with a small ball-and-socket implant. A cup sits in the trapezium bone and a stem sits in the thumb metacarpal. Modern dual-mobility designs, such as the TOUCH® prosthesis, are designed to improve stability.
The trapezium is kept, so the length and mechanics of the thumb are maintained. No tendon is harvested.
Trapeziectomy
The trapezium — the small wrist bone forming the base of the thumb joint — is removed. It is often combined with a tendon procedure (ligament reconstruction and tendon interposition, LRTI, or suspensionplasty) to support the thumb in the space left behind.
Trapeziectomy has been performed for decades, is reliable for pain relief, and involves no implant. The thumb usually settles slightly shorter, and recovery of strength tends to take longer.
What the research shows
Faster recovery and earlier strength
In a two-centre study of 71 patients, those with a joint replacement were off work for an average of 6 weeks compared with 21 weeks after resection arthroplasty, and were pain-free at 1.5 months compared with 5.9 months. Final disability (DASH) scores were also better after replacement. Pinch strength and overall satisfaction were similar between groups, and the replacement took longer to perform.1
A prospective randomised study of the TOUCH® prosthesis against trapeziectomy with tendon interposition found both groups improved, but replacement patients improved faster, with better strength and range of motion throughout follow-up.2 A separate Dutch randomised trial also found a significant advantage in strength and motion after replacement at one year.3
A Spanish comparative study following patients for over five years reported less pain (average pain score 1.3 vs 3.0 out of 10) and better thumb opposition after total joint replacement than after trapeziectomy with ligamentoplasty. Patients were allocated by surgeon rather than randomised.4
Thumb length and a more natural thumb
Because the trapezium is preserved, a replacement maintains the length of the thumb column. A 2026 systematic review of patients over 70 found both operations effective, with prostheses better maintaining thumb length and stability of the knuckle joint (MCP joint), and offering faster recovery.5
When patients have had both: side-by-side studies
Thumb arthritis often affects both hands. Patients who have had a replacement in one thumb and a trapeziectomy in the other are the most direct comparison available — the same person, the same hands, the same daily demands.
| Study | Patients | What they found |
|---|---|---|
| Nietlispach et al., Schulthess Klinik, Zurich (2025)6 | 14 women | 10 would choose the implant again, 1 would choose trapeziectomy, 3 undecided. 12 were satisfied or very satisfied with the implant side vs 8 with the trapeziectomy side. Hand-function scores, key pinch and grip strength were significantly higher on the implant side. |
| Dietrich et al., Inselspital, Bern (2025)78 | 10 patients | All 10 would choose the prosthesis for a hypothetical “third hand”, citing faster recovery, greater strength and a more natural-looking thumb. Most reported more strength and endurance on the replacement side and much less therapy afterwards. |
| Smeraglia et al., multicentre, Italy (2025)9 | 26 patients | Every patient rated the replacement side excellent (73%) or very good (27%), compared with 15% excellent after trapeziectomy with LRTI. Pain, function and strength recovered faster on the replacement side; results converged by two years. |
These are small studies. In the Bern cohort the trapeziectomy side had been followed for longer than the replacement side, which the authors note may influence how patients rated each hand.
“My preference is for replacement over trapeziectomy, as it leaves a more normal, natural-feeling thumb. Since 2025 I have been performing replacements exclusively over trapeziectomies.”
— Dr Oscar Brumby-Rendell
A balanced view: risks and what the evidence does not show
Joint replacement is not risk-free, and trapeziectomy remains a well-proven operation. You should weigh the following:
- Long-term hand-function scores are similar. A 2024 meta-analysis of randomised trials found the benefits of replacement were clearest in the first three months, without a sustained difference in overall scores at one year.10 The Dutch randomised trial likewise found no superiority in patient-reported hand function at five years, although it reported 5-year survival of 93% for joint replacement and 73% for trapeziectomy.11
- Implant-specific complications. These include dislocation, loosening of the cup or stem, and irritation of nearby tendons (De Quervain’s tenosynovitis).12 A 2025 systematic review of dual-mobility implants (931 patients) reported a failure rate of 2.7%, mostly from dislocation and loosening.13
- Long-term data is still accumulating. Trapeziectomy has decades of follow-up. Results beyond ten years for current dual-mobility designs are not yet available.
- There is a fallback. If an implant fails, it can be removed and converted to a trapeziectomy. A matched study found outcomes after this secondary trapeziectomy were comparable with a primary trapeziectomy.14
Who is suitable for thumb joint replacement?
Replacement generally suits people with arthritis confined to the thumb CMC joint and enough healthy trapezium bone to hold the implant — particularly those who want an early return to work, sport, caring or hobbies that rely on grip and pinch.
It may not be suitable where arthritis also involves the surrounding joints of the trapezium (scaphotrapeziotrapezoid, or STT, arthritis), where the trapezium is too small or weak, or after previous surgery on the joint. These factors are assessed with X-rays (and sometimes a CT scan) at your consultation, and other options will be discussed with you if a replacement is not appropriate.
Recovery compared
Recovery programmes vary between surgeons and between patients. As an example from one published comparison:9
| Joint replacement | Trapeziectomy with LRTI | |
|---|---|---|
| Early protection | Soft bandage for about 1 week, then active movement | Thumb cast or brace for about 3 weeks |
| Hand therapy | Gradual return to daily activities after stitches are removed | Around 3 months of rehabilitation to regain motion and strength |
| Strength recovery | Faster, most noticeable at 1–6 months | Slower; continues improving to 12 months |
Your own recovery plan will be explained before surgery. See also post-surgery care and driving after surgery.
Frequently asked questions
Is thumb joint replacement better than trapeziectomy?
Both operations reliably relieve pain. The research consistently shows faster recovery, earlier strength and better-preserved thumb length after replacement, while randomised trials have not shown a lasting difference in overall hand-function scores beyond the first year. Replacement also carries implant-specific risks. The best option depends on your anatomy, your arthritis pattern and what matters most to you.
What do patients who have had both operations prefer?
Across two published studies of patients with a replacement in one thumb and a trapeziectomy in the other (24 patients), 20 said they would choose the replacement again, one would choose trapeziectomy and three were undecided.
How long does a thumb joint replacement last?
Modern dual-mobility implants have encouraging short- to mid-term results; a 2025 review of 931 patients reported a failure rate of about 2.7%. Follow-up beyond ten years for current designs is still being collected.
Can a thumb replacement be converted to a trapeziectomy later?
Yes. If an implant fails, it can be removed and converted to a trapeziectomy, with published outcomes comparable to a primary trapeziectomy.
Do I need a referral?
Yes. A referral from your GP or another specialist is needed to claim a Medicare rebate for a specialist consultation. Once you have one, you can book online or call (08) 7077 0101.
Where do you consult in Adelaide?
Dr Brumby-Rendell consults at Eastwood (Level 5, 204 Greenhill Road) and Stirling Hospital.
References
- Erne H, Scheiber C, Schmauss D, et al. Total endoprosthesis versus Lundborg’s resection arthroplasty for the treatment of trapeziometacarpal joint osteoarthritis. Plast Reconstr Surg Glob Open. 2018;6(4):e1737. doi:10.1097/GOX.0000000000001737
- Guzzini M, Arioli L, Annibaldi A, et al. Interposition arthroplasty versus dual cup mobility prosthesis in treatment of trapeziometacarpal joint osteoarthritis: a prospective randomized study. Hand (N Y). 2023. doi:10.1177/15589447231185584
- de Jong TR, Bonhof-Jansen EEDJ, Brink SM, et al. Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial. J Hand Surg Eur Vol. 2023;48(9):884–894. doi:10.1177/17531934231185245
- Simón-Pérez C, Frutos-Reoyo EJ, Martín-Ferrero MÁ, et al. Total arthroplasty versus trapeziectomy with ligamentoplasty for trapeziometacarpal osteoarthritis: 5-year outcomes. Clin Orthop Relat Res. 2025;483(7). doi:10.1097/CORR.0000000000003404
- Trapeziectomy with LRTI or dual-mobility prosthesis for thumb carpometacarpal arthritis: a systematic review with considerations for elderly patients over 70 years of age. J Clin Med. 2026;15(3):1137. doi:10.3390/jcm15031137
- Nietlispach V, Marks M, Imhof J, Pudic T, Herren DB. Which would you choose again? Comparison of trapeziometacarpal implant versus resection arthroplasty in the same patient. J Hand Surg Eur Vol. 2025;50(2):178–183. doi:10.1177/17531934241265809
- Dietrich LG, Rinaldi V, Vögelin E. Patient perspectives after trapeziectomy versus carpometacarpal prosthesis: a qualitative thematic analysis of ten bilateral cases. J Clin Med. 2025;14(23):8375. doi:10.3390/jcm14238375
- Dietrich LG, Kasparkova K, Silins K, et al. Trapeziectomy vs. carpometacarpal prosthesis: two techniques in an “in vivo” side-by-side comparison. J Plast Reconstr Aesthet Surg. 2025;109:249–251. doi:10.1016/j.bjps.2025.07.043
- Smeraglia F, Carità E, Frittella G, et al. Intra-patient comparison of trapeziectomy with LRTI and dual mobility prosthesis for trapeziometacarpal osteoarthritis: a multicenter observational study. Eur J Orthop Surg Traumatol. 2025;35:329. doi:10.1007/s00590-025-04441-y
- Liukkonen R, Karjalainen VL, Kvist R, et al. Total joint arthroplasty for thumb carpometacarpal joint osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Acta Orthop. 2024;95:325–332. doi:10.2340/17453674.2024.40816
- Bonhof-Jansen EEDJ, de Jong TR, Brink SM, de Wildt RP, Werker PMN. Total joint arthroplasty versus trapeziectomy for trapeziometacarpal joint arthritis: 5-year follow-up of a randomized controlled trial. J Hand Surg Eur Vol. 2026;51:25–33. doi:10.1177/17531934251357456
- Gonzalez-Espino P, Pottier M, Detrembleur C, Goffin D. Touch® double mobility arthroplasty for trapeziometacarpal osteoarthritis: outcomes for 92 prostheses. Hand Surg Rehabil. 2021;40(6):760–764. doi:10.1016/j.hansur.2021.08.005
- Villari P, Guerra G, De Luna V, et al. Dual mobility trapeziometacarpal joint arthroplasty for the treatment of osteoarthritis: a systematic review. Musculoskelet Surg. 2025. doi:10.1007/s12306-025-00882-0
- Cerlier A, Guinard D, Gay AM, Legré R. Outcomes of secondary trapeziectomy after revision of trapeziometacarpal implants: a retrospective comparative matched study. J Hand Surg Eur Vol. 2021;46:1096–1100. doi:10.1177/17531934211039184
This page provides general information only and is not a substitute for individual medical advice. Results of surgery vary between individuals. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.