The decision to reconstruct the carpometacarpal (CMC) joint versus replacement can be a difficult one. There are always pros and cons to every surgical procedure. And each patient is unique in his or her presentation, goals, and expectations.
We recommend a frank conversation with your hand surgeon about these points. We can offer some information from a recent well-done systematic review that might help inform you when deciding what specific questions to ask your surgeon about your own situation.
In this review, hand surgeons tally up the results of studies in this area published from 1966 to 2009. The surgical procedures included 1) removing the trapezium bone (trapeziectomy) and filling in the hole with a spacer or rolled up piece of ligament (interposition), 2) same procedure using a piece of tendon instead of ligament, 3) removal of the trapezium and ligament reconstruction, 4) just ligament reconstruction, or 5) trapeziectomy with both ligament reconstruction and tendon interposition.
There were other surgical procedures as well such as an arthrodesis (joint fusion), joint replacement, or osteotomy. An osteotomy is the removal of a wedge-shaped piece of bone to help realign the entire bone and joint. Once the piece of bone is taken out, the remaining two edges of bone shift toward each other and change the structural alignment.
After reviewing results of studies for each surgical procedure, the following conclusions were made:
At this point, there was no single surgical procedure that stood out as the best one to use for the problem of carpometacarpal (CMC) osteoarthritis (OA). In general, most of the studies only give results after a short period of time (one year). Your surgeon may have some better details for you based on his or her preferences and experience. That’s always good information to have when making a decision like this one.