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Trapeziectomy and suspension arthroplasty
Trapeziectomy and suspension arthroplasty is a surgical procedure that treats arthritis at the base of the thumb by removing the trapezium bone and using a nearby tendon to support and stabilise the joint. It relieves pain and improves thumb movement and grip strength when non-surgical treatments, such as splinting or injections, no longer provide adequate relief.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Commonly overnight, for pain management
First post operative review
Approximately two weeks after surgery
Driving
Not while in the post-operative cast or splint (first 6 weeks)
Post Operative Hand Therapy
Required for splinting, range of movement exercises and strengthening
Splinting
Yes - cast or splint worn for the first six weeks after surgery
Pain relief
Usually paracetamol and/or ibuprofen plus stronger pain relief is generally needed
Return to repetitive & heavy loading
Most usual activities resumed by 3 months; all usual activities, including heavier loading, by 6-12 months
Removal of the trapezium bone with tendon suspension for thumb base arthritis
Trapeziectomy and suspension arthroplasty is surgery for basal joint (thumb base, CMCJ) arthritis. The trapezium bone at the base of the thumb is removed, and half of one of the tendons at the front of the wrist is used to create a sling supporting the remaining thumb bones.
Who is this procedure for?
- People with basal joint (thumb base) osteoarthritis whose pain is constant and unbearable despite non-surgical treatment
- People whose pain limits pinching, gripping, opening jars, turning keys or twisting door handles
- People who have tried splinting, activity modification, paracetamol and corticosteroid injections without lasting relief
- This is Dr Tomlinson's most commonly recommended surgical treatment for basal joint arthritis, over joint resurfacing or fusion
What does the surgery involve?
The surgery is performed in hospital under general anaesthetic. The trapezium, a small wrist bone at the base of the thumb, is removed. Half of one of the tendons on the front of the wrist is then used to create a sling that supports the remaining thumb bones in position. This generally provides durable, proven results without a need for future revision.
Alternatives to trapeziectomy and suspension arthroplasty surgery
Trapeziectomy is one option for basal joint arthritis. Depending on your situation, the alternatives may include:
- Doing nothing for now (watchful waiting): reasonable if pain is manageable with non-surgical measures. Osteoarthritis does not necessarily mean progressive ongoing severe pain – over time your pain may get better, or not worsen.
- Non-surgical management: activity modification, splinting, paracetamol, and corticosteroid injections — recommended as first-line treatment
- A different procedure: joint fusion (arthrodesis), which relieves pain but eliminates joint movement or alternative surgical options such as joint replacement.
What happens if left untreated: pain and functional limitation with pinching and gripping typically continue or worsen.
Dr Tomlinson will discuss which options suit you at your consultation. For a fuller explanation, see the Thumb Base (CMCJ) Osteoarthritis page.
Watch: Understanding Trapeziectomy and Suspension Arthroplasty
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. If your work is desk-based or administrative, you may be able to return at 2-4 weeks after surgery, often with some temporary modifications. If your work is physical – heavy lifting, manual labour or “on tools” – you’ll usually need longer, given the 6-week cast/splint period. As a guide for this procedure: most usual activities by 3 months, all usual activities by 6-12 months. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for six weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 2-4 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication – your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A cast or splint is worn for the first six weeks after surgery.
Will I need to see a hand therapist afterwards?
Yes – hand therapy is an important part of your recovery for this procedure. You will see a hand therapist commencing one week after surgery to be placed in a forearm based thermoplastic splint. Once the early post operative swelling resolves and you regain relatively pain free movement you will begin strengthening under the guidance of your hand therapist.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen plus stronger pain medications in the first 1-3 weeks after surgery.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain – usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling. That this operation is associated with significant early post operative discomfort does increase the risk of CRPS compared to operations where less post operative discomfort routinely occurs.
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Reduced grip and pinch strength compared with before surgery
- Settling (subsidence) of the thumb metacarpal into the space left by the removed trapezium
- Numbness or a tender scar from irritation of a small sensory nerve branch at the base of the thumb
- If a tendon is used for suspension: discomfort at the site the tendon was taken from, or the sling stretching or shifting over time
- Ongoing thumb pain, sometimes requiring further treatment
- Radial artery injury during dorsoradial capsular dissection is possible but usually not clinically significant if recognised intraoperatively.
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 72 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time. You will take regular simple analgesic medications (paracetamol and ibuprofen) and stronger prescription pain medication. You cannot drive and you will need assistance with daily tasks.
First week
Keep the bandages dry and intact until you see your hand therapist and are placed in the recovery splint. Then, keep the dressing dry until you see your surgeon approximately 2 weeks after surgery. You may use your hand for light activities, but listen to your hand and avoid anything that causes pain, You should find that your hand is less painful each day.
Second week
You will be in splint during this period; the surgical site is protected and thumb use is limited while early healing occurs. Your need to take medications for discomfort or pain should be steadily reducing, although you may still require occasional strong analgesic medication.
6 weeks
Full grip strength may take several months to return, and deep-pressure tenderness and discomfort at the surgical site can persist for some months. Massage assists with improving scar mobility and minimising scar firmness. Your hand therapist will guide you in recovery of hand and wrist strength including thumb pinch.
3 months
Most activities will be possible, you will no longer be wearing your post procedure splint, and you will be performing exercises to increase strength in your thumb, hand and forearm. Scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
The aim is to resume most usual activities by 3 months after surgery, and all usual activities by 6 months. The surgery generally provides good, durable pain relief. Pain scores reduce until 12 months after surgery, then are expected to remain stable in the long term. Late complications are uncommon. Osteoarthritis may affect other joints in the treated hand and wrist, or in the other hand.
Want to know more about Trapeziectomy and Suspension Arthroplasty?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.