Which surgery works better to treat osteoarthritis (wear and tear) of the thumb?

Key messages

• Compared with trapeziectomy (removal of the bone at the base of the thumb), trapeziectomy with LRTI (replacing the ligament and strengthening the joint with tendon from the forearm) may provide little to no benefit in pain, function, joint imaging or unwanted effects from 3 to 54 months after treatment.

• We don't know the best surgery to treat osteoarthritis of the thumb. More research is required in this area.

What is thumb osteoarthritis?

Osteoarthritis is a disease of the joints, sometimes called 'wear and tear disease'. Osteoarthritis at the base of the thumb (trapeziometacarpal joint) may cause pain, stiffness and weakness in the thumb. This can affect how well the thumb moves, how strong the grip is and how well someone can do routine things at home or at work.

Although many people suffer from this condition, its effects on how you feel cannot be measured with X-rays. Therefore, osteoarthritis of the thumb is treated based on its effects instead of what is seen on X-rays.

For many people, these effects are very small, and treatment is not necessary. Certain jobs and hobbies can worsen it, especially if the person needs to pinch and grip a lot.

How is thumb osteoarthritis treated?

Osteoarthritis in the thumb can be treated using:

• non-surgical approaches, like splinting or anti-inflammatory medication

• steroid injections

• surgery - often used when the first two methods do not work

There are many types of surgery, but they all aim to reduce pain and increase function (or reduce disability). Most surgeries begin by removing the trapezium bone at the base of the thumb (trapeziectomy) and then reconstructing or securing the joint using ligaments or tendons taken from elsewhere in the body, from a donor, or artificial ones. The most common procedure is trapeziectomy with ligament reconstruction and tendon interposition (LRTI). This involves reconstructing the ligament that holds the bones between the thumb and index finger together and filling the space left behind by the removed bone with spare tendon from the forearm to support the thumb. Other surgeries include leaving the space left behind by the trapeziectomy open on purpose to fill up with scar tissue (haematoma distraction) or replacing the joint entirely with artificial joints (arthroplasty).

What did we want to find out?

For people with thumb osteoarthritis, we wanted to find the best surgical methods to:

• reduce pain, disability, unwanted events, and treatment failure (leading to more surgery), and

• improve quality of life.

We also wanted to see the effects of different methods on people's satisfaction with their treatment and what the joint looked like in an X-ray.

What did we do?
We searched for studies that compared different surgical methods for thumb osteoarthritis. People in the studies could be any age or sex, have severe or mild osteoarthritis, and be anywhere in the world. We compared and summarised the results and rated our confidence in the evidence.

What did we find?

We found 25 studies with 1591 people, mostly women. The studies used various surgical procedures. The most widely used was trapeziectomy with LRTI. Studies followed people for 12 to 120 months.

No studies included placebo surgery (surgery without aiming to correct the arthritis) or sham surgery (fake surgery) as a comparison.

Main results

Compared with trapeziectomy, trapeziectomy with LRTI may provide little to no benefit in pain, function, joint imaging or unwanted effects between 3 and 54 months after treatment (4 studies; 421 participants).

Pain measured on a 0 to 100 scale (0 is no pain) was 2.8 points better with trapeziectomy with LRTI.

• People who had trapeziectomy with LRTI rated their pain as 23.2 points.

• People who had trapeziectomy rated their pain as 26 points.

Physical function measured on a 0 to 100 scale (0 is best function) was 0.01 points worse with trapeziectomy with LRTI.

Unwanted effects: after trapeziectomy with LRTI, 66 more people per 1000 had unwanted effects at the end of follow-up.

• 133 per 1000 people reported an unwanted event with trapeziectomy with LRTI.

• 67 per 1000 people reported an unwanted event with trapeziectomy.

Joint imaging: distance between the scaphoid bone (bone in the wrist) and first metacarpal (bone in the hand connecting your wrist to your thumb) was 0.1 mm worse with trapeziectomy with LRTI compared to trapeziectomy.

Studies did not report people's overall satisfaction with treatment, treatment failure or quality of life.

What are the limitations of the evidence?

We have little confidence in the evidence that trapeziectomy with LRTI reduces pain, improves function, or results in more people reporting unwanted effects, as the studies were small, and the surgical procedures varied considerably across studies.

We are uncertain if any surgery has benefits compared to no surgery, non-surgical therapies or placebo surgery, as we found no studies that assessed these comparisons. Further research is likely to change the estimates of these results.

How up-to-date is this evidence?

This is an update of a review first published in 2005. The evidence is current to 19 May 2025.