Trapezium prosthetic arthroplasty (silicone, Artelon, metal, and pyrocarbon)

Trapezium prosthetic arthroplasty has been utilized to treat basal joint arthritis for nearly five decades in an attempt to mitigate some of the potential disadvantages of trapeziectomy while preserving range of motion. Implant arthroplasty seeks to preserve joint biomechanics, avoids metacarpal subsidence, and should provide immediate stability. These benefits may lead to improvements in strength, durability, and a decrease in metacarpophalangeal joint hyperextension which can occur subsequent to metacarpal shortening. First generation implants were primarily silicone trapezial spacers. While the use of these implants has been curtailed by their association with silicone synovitis, they still remain an option for low demand, rheumatoid patients. More recently developed synthetic spacers such as Artelon interposition arthroplasties have had results inferior to more established procedures including trapeziectomy. A variety of metal total joint prostheses have been developed and some of the more recent designs have shown good short-term outcomes. There are a number of different pyrocarbon implants that have become more recently available which range from trapezial substitution to non-anatomic hemiarthroplasty. Pyrocarbon arthroplasty offers a number theoretical advantages however early results have been mixed and further long term data is required.