What are the surgical options for basilar thumb Osteoarthritis?
The carpometacarpal joint of the thumb, also known as the trapeziometacarpal or basilar thumb joint, is a saddle-shaped articulation with a high propensity for degenerative change. Surgical procedures include implant arthroplasty, tendon interposition arthroplasty, tendon suspension arthroplasty, and arthrodesis. Implants have a high rate of failure, and work continues on a better prosthetic design. Tendon interposition (“anchovy procedure”) entails placing a wad of tendon into the cavity created by removal of some or all of the trapezium. Tendon suspension is similar, except after the trapezium is removed, a weave of tendon is created that supports the thumb metacarpal base like a sling. Both tendon procedures result in a 30% to 40% loss of pinch strength. Arthrodesis is probably the best procedure for longevity of the reconstruction, but it restricts metacarpal motion and requires very precise positioning or function will not be optimal.