Surgical decision-making for thumb carpometacarpal osteoarthritis in patients younger than 50, how anticipate?

Carpometacarpal osteoarthritis of the thumb is classically considered a degenerative disease of middle-aged and elderly patients but may present before age 50. In this younger population, surgical decisions are especially challenging: patients have long remaining hand-use expectations, and any operative intervention, regardless of technique, carries a risk of deterioration, failure, or need for revision. This narrative review aims to analyse the specific challenges associated with the management of carpometacarpal osteoarthritis of the thumb in patients under 50 years of age and to introduce the concept of early surgical intervention. This narrative review aims to analyse the specific challenges associated with the management of the first carpometacarpal osteoarthritis of the thumb in patients under the age of 50, to better define the indications and expected outcomes of early surgical intervention, and to situate the decision to undergo surgery within the context of a long-term preventive strategy.

A narrative review of the literature was conducted, focusing on epidemiology, biomechanics, non-surgical treatment and the main surgical options reported for young or active patients, including arthroscopy, denervation, metacarpal osteotomy, chondrocostal grafting, trapeziectomy, pyrocarbon interposition, total arthroplasty and arthrodesis.

The available literature remains heterogeneous and primarily specific to certain techniques, with variable age thresholds and limited data devoted exclusively to patients under 50 years of age. Most procedures can provide pain relief and functional improvement, but each option has specific limitations. Joint-preserving procedures may delay more definitive surgery but depend on the stage of the disease and the morphology of the joint. Trapeziectomy remains reliable for pain relief but may compromise the height and strength of the thumb. "Interposition implants and total joint prosthetic arthroplasty" may allow for a faster recovery and preserve thumb length but require long-term monitoring and expose patients to mechanical failure or revision. Arthrodesis provides stability and strength but sacrifices mobility and may lead to non-union or adjacent joint degeneration.

In patients under 50 years of age, treatment should not be based solely on anticipated short-term improvement. Surgical indications must be determined upfront, considering disease stage, occupational demands, expected durability, revision risk, and the feasibility and quality of potential salvage procedures.