Imaging of Trapeziometacarpal Osteoarthritis: Preoperative Assessment and Postoperative Evaluation

Osteoarthritis of the trapeziometacarpal joint (TMCJ) is a common cause of pain and functional impairment. Accurate preoperative assessment and postoperative follow-up are essential to optimize surgical outcomes. This review examines the role and comparative advantages of different imaging modalities - radiography, ultrasound, cone-beam computed tomography/computed tomography (CBCT/CT), and magnetic resonance imaging (MRI) - in the preoperative evaluation and postoperative monitoring of TMC osteoarthritis and related surgical procedures, including arthroplasty, ligament reconstruction, and arthrodesis.

This narrative review is based on institutional experience, current literature, and clinical workflow applied to pre- and postoperative imaging of the TMCJ. It emphasizes the indications, limitations, and specific applications of each imaging modality.

Standard radiographs remain the first-line imaging tool for diagnosis and surgical planning. Ultrasound is particularly useful for early, infra-radiographic lesions, dynamic assessment, and soft-tissue evaluation. CBCT/CT provides high-resolution 3D imaging of osseous structures, especially for preoperative planning and postoperative assessment of fusion or implant positioning. MRI offers detailed evaluation of cartilage, ligaments, tendons, and synovial structures, with limitations in the presence of metallic implants. Dynamic imaging, including 4D-CT, shows promise for analyzing joint kinematics and instability. Postoperative complications such as pseudarthrosis, implant loosening, tendon injury, and secondary arthrosis can be effectively monitored using these modalities. Overall, multimodal imaging is critical for comprehensive management of TMC osteoarthritis; combining radiography, ultrasound, CBCT/CT, and MRI tailored to the clinical scenario enhances diagnostic accuracy, guides surgical planning, and enables effective postoperative monitoring.

· Radiographs remain the first-line imaging tool for diagnosis and surgical planning.. · CBCT and CT provide high-resolution 3D evaluation of bony anatomy and implants.. · Ultrasound enables dynamic assessment of ligaments, tendons, and soft tissue complications.. · MRI offers superior soft tissue and cartilage visualization but may be limited by metallic implants.. · Postoperative imaging is essential to detect complications, including pseudarthrosis, malunion, and prosthetic loosening..

· Bouredoucen H. Imaging of Trapeziometacarpal Osteoarthritis: Preoperative Assessment and Postoperative Evaluation. Rofo 2026; 10.1055/a-2808-4634.