Trapeziectomy at The Holly Hospital

What is a trapeziectomy?

A trapeziectomy is an operation to remove the trapezium, a small bone at the base of your thumb that can become worn by arthritis. Removing it creates more space for your thumb to move, so the arthritic bone surfaces are no longer rubbing painfully together.

What conditions does a trapeziectomy treat?

This operation treats arthritis at the base of your thumb, where the trapezium meets your thumb bone. This is very common, especially as you get older, and can be caused by age, activity, a previous injury, or run in families. Over time, it leads to worsening pain, weaker grip, stiffness, and sometimes a change in the shape of your thumb.

What are the benefits of a trapeziectomy?

Surgery gives you the best chance of reducing your pain, which in turn can improve your hand function and most people notice a significant improvement.

Are there different types of trapeziectomy?

Before considering surgery, you may be offered non-surgical treatments first, such as avoiding painful activities, painkillers, splints from a hand therapist, or a steroid (cortisone) injection.

Injections only relieve symptoms temporarily, typically for 3 to 6 months, and become less effective if repeated; they don't cure the underlying arthritis.

If surgery is needed, there are several options. The most common is trapeziectomy alone, where the bone is removed and the gap fills naturally with scar tissue. Some surgeons also use part of a tendon to create a supportive sling in the gap, though this doesn't clearly work better than removing the bone alone in most cases.

Less commonly, your surgeon might suggest fusing the joint with a screw, plate or staple to stop it moving altogether, an option sometimes used for younger people doing manual work, or in specific cases, replacing the joint entirely, similar to a hip or knee replacement.

What happens before a trapeziectomy?

On the day of your operation, a nurse will check your details, medications and medical history, and place an identity band on your other arm. You should remove any rings beforehand, and let the team know if you're unwell or have any cuts on your hand or arm, as this may mean delaying your operation.

You'll need to fast for at least 6 hours beforehand, though you can drink clear water up to 2 hours before. You'll also see an anaesthetist, who will check your health and discuss your anaesthetic options with you.

What happens during a trapeziectomy?

Trapeziectomy is usually a day case procedure. It generally involves the following:

1. You're given an anaesthetic – this might be a general anaesthetic so you're fully asleep, or a regional block that numbs your whole arm for around 12 hours while you stay awake
2. Your surgeon makes a cut a few centimetres long over the trapezium, either on the back or palm side of your hand
3. The bone is carefully separated from the surrounding tissue and removed; if there's arthritis in a neighbouring bone too, that's treated at the same time
4. The wound is closed with stitches, and your thumb is protected with a splint, plaster cast, or bulky dressing, with your arm supported in a sling.

The operation itself usually takes between 30 and 90 minutes, depending on which specific procedure you're having.

What does recovery from a trapeziectomy look like?

Most people go home the same day, once they've recovered from the anaesthetic and have someone to take them home and stay with them overnight. Very occasionally, an overnight stay in hospital is needed.

How long you're in a cast or splint varies between hospitals, from around 2 weeks up to 6 weeks, and you'll have a follow-up appointment to check your wound and adjust your splint or cast during this time.

It's important to keep your hand elevated and avoid letting it hang down, as this increases swelling and discomfort.

Your thumb is likely to feel weak for around 12 weeks, so activities are usually reintroduced gradually: light tasks like washing or writing from around 6 weeks, medium tasks like using scissors or driving from around 8 weeks, and heavier tasks like gardening, lifting, or contact sport from around 12 weeks.

Returning to work depends on your job: around 4 to 6 weeks for supervisory or office-based roles, up to 12 to 16 weeks for more physical jobs, and as long as 4 to 6 months for heavy manual work.

Grip strength and pain continue to improve for up to a year after surgery, though most people return to their normal activities within 4 to 6 months.

Your scar, usually a few centimetres long, may look red and feel tender at first, but this settles with time. Once it's healed, massaging it firmly with an unperfumed cream several times a day can help it soften.

What are the risks and complications of a trapeziectomy?

As with any operation, there's a risk of bleeding, bruising, swelling, or infection, and occasionally blood collects under the wound (a haematoma) or the wound edges separate.

Bleeding usually stops on its own, though it's more likely if you're on blood-thinning medication, which your doctor will advise you about before surgery.

A small nerve near the incision can be affected, which may leave a numb patch or a tender spot on the back of your hand – this is usually temporary, though it occasionally needs a further small operation.

Continued pain or weakness afterwards is fairly common to some degree, and your grip is unlikely to fully return to how it was before you developed arthritis.

Removing the trapezium can also let the surrounding bones shift slightly out of place, though this rarely causes noticeable problems.

A small number of people develop complex regional pain syndrome, a poorly understood reaction causing ongoing pain, stiffness and swelling, which is treated with painkillers and physiotherapy and can take weeks or months to settle.