If you have thumb pain from arthritis at the base of your thumb, you may have heard of different surgery options. Two common surgeries are simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition. These names sound complicated, but we will explain them simply.
Doctors have done many studies comparing these two surgeries. This new research looked at all those studies to see if one surgery is better than the other. What they found may surprise you.
Here are three important things to know:
- Both surgeries remove a small bone in your thumb to reduce pain.
- Many studies have compared these surgeries, but the results are confusing.
- The quality of the studies has serious problems.
Key Findings at a Glance
- Seven systematic reviews compared two thumb surgeries between 2004 and 2022
- All seven reviews had serious quality problems and got the lowest quality rating
- Most reviews did not follow a written plan before they started
- Many reviews did not explain why they left out certain studies
- The poor quality makes it hard to trust which surgery is better
In This Article
What is Thumb Arthritis?
Thumb arthritis happens at the bottom of your thumb where it meets your wrist. The medical name is trapeziometacarpal osteoarthritis. That means the cartilage, which is the soft cushion between bones, wears away. Another name you might hear is rhizarthrosis.
When the cushion wears away, the bones rub together. This rubbing causes pain, swelling, and stiffness. Simple tasks like opening a jar or turning a key become difficult.
You may be wondering why this matters. Understanding the problem helps you understand the solution.
What Are the Two Types of Surgery?
When other treatments do not help, doctors may suggest surgery. Two common surgeries are used to treat this thumb arthritis.
Simple Trapeziectomy
This surgery removes the trapezium bone. The surgeon takes out the small bone that is causing the pain. This is called simple trapeziectomy. The word trapeziectomy means removing the trapezium.
After removing the bone, the space is left empty. Over time, scar tissue fills the space. Your thumb can still move and work.
Trapeziectomy with Ligament Reconstruction and Tendon Interposition
This surgery also removes the trapezium bone. But the surgeon does more. They use a piece of tendon to fill the space. A tendon is a strong cord that connects muscle to bone.
The surgeon also rebuilds ligaments. Ligaments are bands that hold bones together. This extra work takes more time during surgery. Doctors call this procedure LRTI for short.
Here is where it gets interesting. Many doctors prefer LRTI even though it is more complicated. But is it actually better?
What Did the Researchers Look At?
According to this study, researchers wanted to know if the published studies comparing these two surgeries were done well. They did something called a systematic review of systematic reviews.
Research shows that they searched medical databases from 1946 to September 2023. They looked for systematic reviews that directly compared simple trapeziectomy versus LRTI.
They found seven systematic reviews published between 2004 and 2022. These seven reviews had looked at the original studies comparing the two surgeries.
Let us look closer at what they discovered.
What Quality Problems Did They Find?
The researchers used a tool called AMSTAR 2 to check the quality of each review. This tool looks at how carefully the reviews were done.
Studies indicate that all seven reviews received the lowest possible quality rating. The rating was called critically low. This means every single review had serious problems.
What Were the Main Problems?
According to medical evidence, the most common problems were:
| Problem Found | How Many Reviews |
|---|---|
| Did not follow a written plan made before starting | 5 out of 7 reviews |
| Did not list which studies they left out and explain why | 5 out of 7 reviews |
| Did not consider if the original studies had bias problems | 4 out of 7 reviews |
| Did not explain how they combined the numbers from different studies | 4 out of 5 reviews that combined numbers |
Why Not Having a Written Plan Matters
When researchers start without a written plan, they might accidentally look for results that support what they already believe. A written plan made before starting keeps the research honest.
Five of the seven reviews did not show they had made a plan ahead of time.
Why Listing Excluded Studies Matters
When researchers leave out certain studies, they should tell you which ones and explain why. This helps you see if they left out important information.
Five reviews did not do this clearly.
Why Considering Bias Matters
Some original studies may have problems that make their results less trustworthy. Good reviews talk about these problems when they explain the results.
Four reviews did not think carefully about these problems when discussing what they found.
Why Does This Matter to You?
You may be wondering how this affects your decision about surgery.
When studies have serious quality problems, we cannot be confident about what they tell us. The researchers found that even though LRTI is more popular with surgeons, the evidence does not clearly show it is better than simple trapeziectomy.
The reviews gave conflicting results. Some said one surgery was better. Others said there was no difference. Because all the reviews had quality problems, we cannot know which conclusion is right.
This means the question is still open. More careful research is needed.
What Should You Do?
Talk with your doctor about both surgery options. Ask about their experience with each type. Ask what results their patients have had.
Remember that the simpler surgery might work just as well as the more complicated one. The choice should be based on your specific situation.
About This Site
This website helps people understand medical research about thumb pain and rhizarthrosis. We read scientific articles published in medical journals and explain them in simple language.
We only use information from real published studies. We never make up facts or give personal medical advice. Our goal is to help you understand what science says so you can have better conversations with your doctor.
Feel free to explore more articles on our site. Each one breaks down a different piece of research about thumb arthritis.
Frequently Asked Questions
Is one surgery definitely better than the other?
According to this research, we cannot say for certain. The studies comparing the two surgeries have quality problems that make it hard to trust the conclusions. Both surgeries can help reduce thumb pain, but more careful research is needed to know if one is truly better.
Why do doctors prefer the more complicated surgery?
Many surgeons choose LRTI, the more complicated surgery, even though evidence does not clearly show it is better. The reasons are not fully explained in this research. It may be based on training, tradition, or personal experience rather than strong scientific proof.
What does critically low quality mean?
Critically low quality is the lowest rating a study review can get. It means the review has serious problems in how it was done. These problems make it hard to trust the results. All seven reviews in this research got this low rating.
Should I avoid surgery because of these findings?
No. This research does not say surgery does not work. It says we need better studies to know which type of surgery is best. Both surgeries can help people with thumb arthritis. Talk with your doctor about what is right for you based on your specific case.
What This Means for You
If you have thumb arthritis and are thinking about surgery, know that both options have helped many people.
This research shows that the studies comparing these surgeries have not been done as carefully as they should be. That does not mean the surgeries do not work. It means we need better research to know which is best.
The most important step is to find a surgeon you trust. Ask them about their experience with both types of surgery. Ask how their patients have done. Share your concerns and your goals for your thumb.
You deserve clear answers based on good evidence. Until better studies are done, your choice should be made with your doctor based on your unique situation.
Important Disclaimer
This article explains medical research in simple terms. It is for educational purposes only.
This is not medical advice. It does not replace talking with your doctor. Every person is different. What works for one person may not work for another.
If you have thumb pain or questions about surgery, please see a qualified healthcare provider. They can examine you and recommend treatment based on your specific needs.
Research Source
This article is based on research by Fang, Evan; Behroozian, Tara; Thoma, Achilles, published in the Journal of Hand and Microsurgery in 2025.
https://doi.org/10.1016/j.jham.2024.100160
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