Clinical management of trapeziometacarpal joint infections: a European Delphi consensus and literature review

Periprosthetic joint infections (PJIs) of the trapeziometacarpal joint of the thumb are rare but challenging complications of arthroplasty. Currently, no hand-specific guidelines exist. This study aimed to develop consensus-based recommendations for their diagnosis and management.

A three-round Delphi process was conducted with seven European hand surgeons experienced in trapeziometacarpal joint arthroplasty. Consensus was defined as ⩾80% agreement (strong) and 65-79% (moderate). A scoping literature review of hand and large-joint PJIs was performed to support expert statements.

All suspected infections were recommended to be managed surgically, with strong support for debridement and prosthesis neck exchange in acute infections. Trapeziectomy was endorsed as a salvage strategy in acute and chronic cases. Six weeks of antibiotic therapy, initiated intravenously and followed by oral administration, was strongly recommended. Amoxicillin/clavulanate and clindamycin were preferred empirical agents. The use of rifampicin was conditionally supported in confirmed Staphylococcus aureus infections. A 12-week interval between intraarticular corticosteroid injection and prosthesis implantation was recommended.

This Delphi process, supported by literature review, provides the first structured guidance for the management of PJIs of the trapeziometacarpal joint of the thumb. Recommendations align with principles from large-joint infection management but are tailored to the anatomical and clinical context of the hand. These statements establish a practical framework for clinical decision-making and highlight priorities for future research.

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