Best Surgical Treatments for Thumb Osteoarthritis: Trapeziectomy vs. LRTI

Comparing surgical interventions for osteoarthritis at the base of the thumb reveals that adding a ligament reconstruction and tendon interposition (LRTI) to a trapeziectomy provides little to no meaningful clinical benefit in pain reduction or functional improvement between 3 and 54 months post-treatment, according to an updated review current to May 19, 2025.

Key Clinical Takeaways:

• Efficacy Parity: Trapeziectomy combined with LRTI shows virtually no superior impact on pain or physical function compared to trapeziectomy alone across multiple clinical trials.
• Adverse Events: Patients receiving the combined LRTI procedure report slightly higher rates of unwanted side effects, averaging 133 per 1,000 cases compared to 67 per 1,000 for trapeziectomy alone.
• Research Gaps: Current evidence remains limited by small sample sizes and broad procedural variations across studies, highlighting a need for more rigorous trials comparing surgery against non-surgical alternatives.

Understanding Thumb Osteoarthritis and Surgical Standards

Osteoarthritis of the trapeziometacarpal joint at the base of the thumb manifests as progressive cartilage wear, driving pain, stiffness, and diminished grip strength that can disrupt routine daily activities. Because radiographic imaging does not reliably correlate with a patient’s lived experience of pain, clinical management relies heavily on functional impact rather than X-ray findings. When non-surgical approaches like splinting, anti-inflammatory medications, and corticosteroid injections fail to control symptoms, physicians frequently turn to operative interventions.

The standard surgical landscape centers on removing the trapezium bone, known as a trapeziectomy. Surgeons often perform this alongside ligament reconstruction and tendon interposition (LRTI), utilizing a spare tendon harvested from the forearm to reconstruct local ligaments and fill the void left by the removed bone. Alternative techniques include haematoma distraction—leaving the empty space to fill with scar tissue—or total joint arthroplasty using artificial implants.

Trial Evidence and Comparative Outcomes

To evaluate these methods, the systematic review analyzed 25 studies encompassing 1,591 participants, predominantly women. The investigation focused primarily on comparing standalone trapeziectomy against the more complex trapeziectomy with LRTI. Data extracted from four trials involving 421 participants demonstrated that LRTI yielded marginal differences in patient-reported pain scores. Measured on a 0 to 100 scale where lower numbers indicate less pain, patients who underwent trapeziectomy with LRTI reported an average pain score of 23.2, while those who received a trapeziectomy alone averaged 26 points—a difference of just 2.8 points.

Physical function, evaluated on a 0 to 100 scale where higher scores represent optimal function, showed virtually identical outcomes, registering a minuscule 0.01-point disadvantage for the LRTI group. Joint imaging similarly revealed negligible structural variance; the distance between the scaphoid and the first metacarpal bone differed by a mere 0.1 millimeters between the two cohorts.

Evaluating Adverse Events and Evidence Limitations

While clinical efficacy remained comparable, safety profiles diverged slightly regarding unwanted events. Documented complications occurred at a higher frequency among patients receiving the tendon transfer. Specifically, 133 per 1,000 participants reported an unwanted event following trapeziectomy with LRTI, compared to 67 per 1,000 individuals treated with trapeziectomy alone. This indicates that adding the harvesting and reconstruction steps introduces additional morbidity without conferring a corresponding therapeutic advantage.

The overall confidence in these findings remains low due to methodological limitations across the underlying literature. The analyzed studies featured relatively small cohorts and substantial variations in surgical execution, complicating direct comparisons. Furthermore, the review noted an absence of trials evaluating surgical interventions against placebo procedures, sham surgeries, or non-surgical baselines, leaving open questions about the definitive baseline value of operating versus conservative management.

Future Trajectory and Clinical Pathways

The lack of demonstrable superiority for LRTI challenges longstanding assumptions regarding soft-tissue interposition in thumb base reconstruction. As clinical research progresses toward standardizing outcome measures and executing larger, multi-center trials, surgical decision-making will likely lean toward simpler procedures that minimize patient morbidity.