Resection arthoplasty of the trapezium with ligament reconstruction and tendon interposition and variations

Objective Creation of a pain-free, flexible and stable (pseudo) joint between the carpus and the base of the 1st metacarpal bone. Indications Painful carpometacarpal (CMC)-I joint due to primary or secondary osteoarthritis, CMC-I instability. Contraindications Carpal instability, local infection, tumors. Surgical technique Resection of the trapezium (and of the arthritic joint surfaces in CMC-I and STT [scaphoid-trapezium-trapezoid-joint]), stabilization of the base of the 1st metacarpal bone by suspension with a distally pedicled strip of the flexor carpi radialis tendon or variants thereof. Postoperative management Immobilization in a splint for 3-5 weeks, followed by hand therapy. Results Worldwide for almost 40 years, regardless of the exact technique, almost always (90%) significant pain reduction, increased strength in the grip and slightly less in the pinch grip, very good mobility, 85-95% very satisfied patients and very good long-term results.