Trapeziometacarpal joint arthroplasty: avoiding imbalance and optimizing outcomes.

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Hand Surgery

Background:

• Trapeziometacarpal (TMC) joint osteoarthritis is a prevalent condition leading to pain, reduced pinch strength, and characteristic Z-deformity.
• Understanding the biomechanical progression, including metacarpal subluxation and ligamentous weakening, is crucial for effective surgical management.
• The disease process involves anterior beak resorption, altered joint mechanics, and compensatory muscle actions contributing to deformity.

Purpose of the Study:

• To review the pathomechanics of trapeziometacarpal joint osteoarthritis progression.
• To discuss the principles and outcomes of trapeziometacarpal joint arthroplasty in correcting deformity and restoring thumb function.
• To highlight the role of component selection, alignment, and implant design, such as dual-mobility prostheses.

Main Methods:

• Review of the biomechanical factors contributing to TMC joint osteoarthritis.
• Analysis of surgical techniques and implant considerations for TMC joint arthroplasty.
• Evaluation of outcomes associated with modern arthroplasty, including dual-mobility designs.

Main Results:

• Arthroplasty aims to restore thumb column balance by correcting basal joint deformity.
• Dual-mobility designs have demonstrated reduced dislocation rates compared to single-mobility implants.
• Careful surgical technique, including osteophyte resection, is essential for preventing impingement and ensuring stability.

Conclusions:

• Modern TMC joint arthroplasty, especially with dual-mobility prostheses, offers reliable deformity correction.
• These procedures lead to improved stability and durable outcomes in patients with advanced TMC osteoarthritis.
• Metacarpophalangeal joint hyperextension often resolves post-arthroplasty due to secondary soft-tissue stabilization.