Two operations relieve the pain of arthritis at the base of the thumb when splints, therapy and injections no longer do. A trapeziectomy removes the worn trapezium bone and holds the thumb in position with a suture button implant while the space fills with scar tissue. A joint replacement keeps the bone and resurfaces the joint with a small implant, the Touch prosthesis. Both are done at GRIP, both work well, and they suit different thumbs and different lives. This page sets out how the two differ, who each one suits, what the evidence says, and what our own audited results look like, so that the conversation in the consulting room starts from facts rather than from which operation is newer.
The two operations in one paragraph each
Trapeziectomy with suspensionplasty. The trapezium, the small bone the thumb sits on, is removed through an incision at the base of the thumb. Without the bone the painful joint no longer exists. The thumb then has to be held in position while the space fills with scar tissue. The method we use is a suture button implant, which is called a suspensionplasty. It holds the thumb metacarpal in position against the neighbouring index finger metacarpal while that scar tissue forms, through a small second incision on the back of the hand, and it avoids taking a tendon out of your forearm to do the same job. The first weeks need protection in a removable splint while the scar tissue matures.
Touch joint replacement. The worn joint surfaces are removed, but the trapezium stays. A small titanium cup, coated so that bone grows onto it, is pressed into the trapezium. A titanium stem goes into the thumb metacarpal and carries a polished neck and ball. A polyethylene insert links the two in a dual mobility design, which means the ball moves inside the insert and the insert moves inside the cup, the same idea as a small hip replacement. The thumb keeps its own height and length, and because nothing has to scar in to become stable, movement starts earlier.
What the evidence says
The two operations have now been compared head to head in randomised trials, mostly from Europe, where the implants have been in use longest.
- Recovery is faster after a replacement. Pooled across four randomised trials, hand function at three months was about 18 points better on the 100 point DASH scale after a replacement than after a trapeziectomy, and grip was about 3.7 kg stronger. That is a real and noticeable difference in the first months.
- By one year the difference in function has largely gone. The same trials show a difference of about 4 DASH points at one year, which patients do not notice, and pain scores within half a point of each other.
- Strength may stay a little higher after a replacement. At two years, grip was about 6 kg and key pinch about 1.4 kg stronger after a replacement. The certainty of this finding is low to moderate.
- A replacement carries implant specific risks that a trapeziectomy does not. Dislocation of the prosthesis, loosening, and tendonitis of the thumb tendons that run over the implant are reported after 2 to 6 percent of replacements in modern dual mobility series. The trials suggest reoperation is more likely after a replacement, roughly twice as likely, though the numbers are small. Two year implant survival in the largest dual mobility series is about 96 to 98 percent.
- At five years, patient reported outcome is the same. The one randomised trial with five year follow-up found no difference in hand outcome score, pain, grip or tip pinch between the two operations.
In plain terms: the replacement gets you back to using the thumb sooner and may leave it slightly stronger; the trapeziectomy has no implant to dislocate, loosen or wear, and a sixty year track record. Both relieve pain reliably.
Who suits which operation
These are the factors we weigh. None of them decides on its own.
A joint replacement is favoured when:
- the arthritis is confined to the thumb base joint and the joint next to it, the STT joint, is healthy on the X-ray
- the trapezium has enough good bone to hold a cup, which rules out a bone that is badly worn, hollowed or collapsed
- you need pinch and grip strength back quickly, for work, sport or caring for someone
- you are under about 65 and expect decades of heavy use, where the early strength matters most and a later conversion to trapeziectomy, if ever needed, is still possible
- the thumb has not been operated on before
A trapeziectomy is favoured when:
- the STT joint is also arthritic, because a replacement does nothing for that joint and the pain would continue
- the trapezium is too small, too soft or too worn to hold an implant, which is common in advanced disease and in osteoporosis
- there is a marked collapse of the thumb into a Z shape, which often needs the joint above it stabilised at the same time
- you want an operation with no implant to look after and no possibility of implant failure years later
- an earlier operation on the joint has failed, including a failed replacement
Either operation when: the arthritis is stage II or III on the X-ray, the trapezium is sound, and your priorities are the ordinary ones of a pain free thumb that opens jars and turns keys. Then we talk about recovery speed against implant risk, and the decision is yours.
Neither operation when: symptoms are still controlled by a splint and an occasional injection. Surgery is for a thumb that limits your life despite those, not for an X-ray.
Our own results
We audit our operations by reading every patient's record against fixed rules, so that the figures we quote are ours and not borrowed from a journal. Both audits below are retrospective chart reviews: the grades come from what was written at the reviews, not from a trial, and that is a limitation we state plainly.
Trapeziectomy at GRIP, 2019 to 2026
A single surgeon series was audited: every trapeziectomy with suspensionplasty performed at GRIP by that surgeon from April 2019 to September 2026, which is 286 primary operations in 250 patients, median age 67, followed for a median of 4.3 years.
Excellent or good result, where the result was due to the thumb base operation. Ours: 90% (223 of 247). Published five year series: not reported this way.
No or mild pain at the last review. Ours: 95%. Published five year series: median pain 1.5 of 10.
Satisfied, where recorded. Ours: 96%. Published five year series: 91%.
Kapandji opposition score, median. Ours: 9 of 10. Published five year series: 9.2.
Major complication due to the operation. Ours: 1%.
Free of revision at 5 years. Ours: 97%.
Patients aged 70 and over did better than those under 60 (96% against 84% excellent or good), which is one of the reasons age sits in the list above.
Touch joint replacement, our first 22 cases, 2025 to 2026
The replacement is a newer operation in our practice, and we say so. Our first 22 Touch replacements have been reviewed: 17 done at GRIP, audited on the same rules in November 2026 and followed for a median of about five weeks at the time of the audit, and 5 done by the same surgeon at another hospital and reviewed on the same measures. Most were done in 2026, so these are early figures and will be updated as the series grows and as patients reach twelve months.
Patients. Ours: 22 operations in 22 patients. Published series, 2 to 4 years: 150 prostheses in 138 patients.
Excellent or good result, of the 14 followed long enough to grade. Ours: 13 of 14. Published series, 2 to 4 years: 98% would have the other side done.
Thumb opposition (Kapandji) at the last review. Ours: 10 in 7 of 13 measured, 9 in 5. Published series, 2 to 4 years: 9.7 at one year.
Dislocation. Ours: none. Published series, 2 to 4 years: 0.5 to 2%.
Infection or loosening. Ours: none. Published series, 2 to 4 years: loosening or migration 2 to 4%.
Tendonitis of the thumb tendons after surgery. Ours: none (the tendon tunnel is released at the operation). Published series, 2 to 4 years: 6 to 7%.
Revision surgery. Ours: 1 of 22. Published series, 2 to 4 years: revision 2 to 4.5% at two years.
In the one patient followed to ten months, grip on the operated side matched and then exceeded the other hand, which is the strength recovery the trials describe.
Recovery after a trapeziectomy, week by week
Indicative. Recovery here is measured in months rather than weeks, and hand therapy runs throughout.
Day of surgery. Some or all of your fingers may feel numb or tingly for two to three days because of the local anaesthetic. You can move your fingers and the tip of your thumb before you leave hospital.
Days 1 to 5. Keep the dressing clean and dry. There will be swelling of the hand and fingers, best managed by keeping the hand elevated. You will see the hand therapist, who replaces the dressings with a custom made thermoplastic removable splint.
Days 5 to 14. If the hand feels comfortable the splint can be removed for gentle exercises and hand hygiene, but should be worn at all other times. The tape bandage can get wet when you clean your hand gently or shower. You can use the hand lightly wearing the splint, but avoid heavy tasks.
Two weeks. Your progress is reviewed by the doctor, hand therapist or practice nurse. If needed, a new tape bandage goes on for another three to five days. You can remove the splint more regularly to do hand and thumb exercises as instructed.
Four to six weeks. You can use the splint less as tolerated, or stop splinting completely. The wounds have usually healed by two weeks. Follow up appointments continue to monitor progress.
Three to six months. The area around the base of the thumb can remain somewhat tender or swollen through this period, but continues to improve. Useful strength also takes three to six months to recover.
Up to twelve months. Strength continues to improve for up to a year after surgery. Experienced hand therapists will assist you throughout.
Driving and work. Most people drive again once splinting stops, at four to six weeks. Office work is usually manageable at about two weeks, wearing the splint. Heavy work at around three months, in line with when useful strength returns.
Recovery after a joint replacement, week by week
Indicative. The splinting schedule protects the implant while bone grows onto it, so the early stages are less flexible than after a trapeziectomy.
Day of surgery. Your hand and thumb may feel numb or tingly for up to 24 hours because of the local anaesthetic block. You can move your fingers before you leave hospital. Your thumb and wrist are supported in a plaster backslab.
Days 1 to 10. Keep the plaster clean and dry. Keep the hand elevated to reduce swelling. Move your fingers, elbow and shoulder regularly to prevent stiffness.
Days 10 to 14. Your progress is reviewed by the doctor, hand therapist or practice nurse, and the sutures are removed. The plaster is replaced with a custom made removable thumb spica splint fitted by your hand therapist. Gentle, guided thumb and wrist movement begins out of the splint.
Three to four weeks. The splint is gradually weaned during the day, while still worn at night and for protection. Hand therapy progresses to active thumb movement and light functional use of the hand. Heavy lifting, pinching and gripping are avoided.
Six weeks. Your progress is reviewed and new X-rays are taken. Most people have stopped using the splint by this time. Light to moderate use of the thumb is permitted, with strengthening guided by your hand therapist.
Three months. A graded return to heavier activities is started, including most work and recreational tasks.
Six months. Return to heavier manual tasks and sport. Follow up appointments continue as required to monitor your progress.
Six to twelve months. Full strength and stamina continue to build. The thumb may remain stiff, swollen or tender for several months, but this keeps improving.
Driving and work. Most people drive again once splinting stops, at four to six weeks. Office work is usually manageable at about two weeks, wearing the splint. Heavier activities, including most work, from three months, and heavy manual work and sport from six months.
Skin wounds heal in two to three weeks after either operation. A trapeziectomy takes about 45 to 60 minutes and a joint replacement about 60 to 90 minutes. Both are day surgery procedures under a general anaesthetic, with a local anaesthetic given at the same time for comfort afterwards.
Risks that differ
Both operations share the ordinary risks of hand surgery: infection, wound healing problems, stiffness, a tender scar, irritation of the small sensory nerves on the back of the thumb, and the rare complex regional pain syndrome. Beyond those:
- After a trapeziectomy: tingling or tenderness of a small skin nerve near the thumb scar in about 18 in 100, which usually settles with hand therapy, an ongoing ache at the base of the thumb in about 2 in 100, and revision surgery in about 3 in 100 within five years.
- After a replacement: dislocation of the implant, loosening of the cup or stem over time, tendonitis of the thumb tendons that cross the implant, and in a small number conversion to a trapeziectomy. The implant's lifespan is not unlimited, and a replacement done at 55 may need attention at 75.
Frequently asked questions
Is the replacement better because it is newer?
No. Newer is not a reason to choose an operation. The trapeziectomy has decades of results and remains an excellent operation. The replacement earns its place through faster recovery and strength, at the cost of implant risks. We recommend whichever suits your thumb and your life.
Can a replacement be converted to a trapeziectomy if it fails?
Yes. Because the trapezium is kept, a failed or worn implant can be removed and the thumb treated with a trapeziectomy. It is one of the reasons the replacement is reasonable in younger patients. The reverse is not possible: after a trapeziectomy there is no bone left to hold an implant.
Why do you check the STT joint so carefully?
Because arthritis there is the commonest reason a replacement disappoints. The implant resurfaces only the thumb base joint; pain from the joint next door continues. If the STT joint is worn, a trapeziectomy, which can be combined with treatment of that joint, is the better operation.
Does the replacement last?
Published series report 96 to 98 percent of implants in place at two years and high satisfaction at five to ten years, and the modern dual mobility design has clearly fewer dislocations than earlier implants. Nobody can give you a lifetime figure yet, and we do not.
Will I be stronger after a replacement?
Probably a little, and sooner. Trials show grip and key pinch recover faster after a replacement and may stay a few kilograms higher. After either operation useful pinch and grip return over a few months, and strength keeps improving for up to a year.
Why a suture button rather than a tendon?
This one applies to the trapeziectomy. Both a suture button implant and a strip of tendon stabilise the thumb after the bone is removed, and both work. Using a suture button avoids taking a tendon out of your forearm, which means one less thing to recover from. We will go through the reasoning at your consultation.
Which operation do you do more often?
Trapeziectomy, by a wide margin, because many of the thumbs we see have advanced disease, a worn trapezium or an arthritic STT joint, and because many patients prefer an operation with no implant. The replacement is offered where the thumb and the patient suit it.
Do I need a referral?
Yes, a referral from your GP or another specialist for a surgical consultation. No referral is needed to see our hand therapists for a splint or an assessment.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 8 November 2026