The treatment of trapeziometacarpal arthritis with arthrodesis

In this article, the authors discussed the indications for TM arthrodesis, the surgical approach, the types of fixation, expected outcome, and complications. Fusion of the thumb TM joint allows maintenance of pinch and grip strength and provides relief of pain, but limits thumb mobility. An important factor in the success of the arthrodesis is correct thumb position. Trapeziometacarpal joint arthrodesis is advantageous over soft tissue interposition when grip and pinch strength are to be maintained. After TM fusion, however, there are increased stresses across the peritrapezial joints that can cause laxity, pain, and arthritis. Treatment of this may require additional surgical intervention. Treatment of TM arthritis with soft tissue interposition has the advantages of pain relief and increased mobility, but pinch and grip strength are reduced to approximately 75% of normal and rate of reoperation is minimal. The authors recommend TM arthrodesis in the young active person with arthritis limited to the TM joint in whom strong pinch and grip are required. Arthrodesis of the TM joint is safe and predictable and has good subjective and objective results.