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Trapeziectomy for CMC OA — SCE Rheumatology MCQ

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ModerateOsteoarthritisTrapeziectomy for CMC OASCE Rheumatology

A 60-year-old woman has advanced, isolated first carpometacarpal osteoarthritis causing persistent thumb-base pain and impaired pinch function. Symptoms remain unacceptable despite supported self-management, activity modification, analgesia, splinting and an intra-articular corticosteroid injection. Radiographs show no clinically significant scaphotrapeziotrapezoid osteoarthritis. Which is the most appropriate established surgical procedure?

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Correct answer: D — Simple trapeziectomy

The correct answer is D: simple trapeziectomy. This patient has advanced, isolated thumb-base OA with continuing pain and functional impairment despite an appropriate stepwise non-operative programme, making surgery reasonable. Current UK hand-surgery guidance supports excision of the trapezium and finds no demonstrated benefit from routinely adding ligament reconstruction or tendon interposition. First CMC arthrodesis may be selected in some younger, high-demand patients but sacrifices motion and carries risks including non-union. Prosthetic replacement is an alternative in selected patients but introduces implant-specific failure and revision risks and is not the default established procedure. First metacarpal osteotomy is generally considered for earlier disease, while scaphotrapeziotrapezoid arthrodesis does not treat isolated first CMC OA.

Reference: British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST): Gangopadhyay S et al. Guideline on managing thumb base osteoarthritis: BEST findings and recommendations. Journal of Hand Surgery (European Volume). 2025;50(5):576–586. https://pubmed.ncbi.nlm.nih.gov/39852312/