There are two main types of surgery for basal thumb joint arthritis. Surgeries that maintain the trapezium bone and surgeries that remove the bone (trapeziectomy).
The most common surgery for basal thumb arthritis is Ligament Reconstruction with Tendon Interposition, commonly referred to as the LRTI or Anchovy procedure. While this procedure has been proven to provide pain relief, there are numerous reasons that some surgeons choose procedures that leave the trapezium intact.
- The trapezium bone provides base support for the metacarpal. This in turn allows for patients to maintain pinch and grip strength. It also helps ensure that there will be little to no shortening of the thumb. In many cases, when the trapezium bone is removed, the metacarpal will begin to subside (move down) into the joint space where the trapezium bone once was located. This not only may reduce strength but also create a web-like appearance of the thumb.1
- If the trapezium bone is left intact and a primary surgery fails, traditional surgeries like the LRTI still may be performed.2 Once the trapezium bone is removed, there are very few revision options available.
1. Molin U, Evans K, Wilcke M. Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy? J Plast Surg Hand Surg. 2021 Mar 29:1-5. doi: 10.1080/2000656X.2021.1898975. Epub ahead of print. PMID: 33781165.
2.James W. Pritchett MD, Louis S. Habryl DO. A Promising Thumb Basal Joint Hemiarthroplasty for Treatment of Trapeziometacarpal Osteoarthritis. Clinical Orthopaedics and Related Research. April 2012