Evolution of Total Trapeziometacarpal Arthroplasty: From Early Prosthetic Designs to Contemporary Dual-Mobility Systems.

Abstract

Trapeziometacarpal osteoarthritis is a common cause of pain, weakness, and functional impairment. Although trapeziectomy-based procedures remain the benchmark surgical treatment, concerns including metacarpal subsidence, prolonged rehabilitation, and delayed strength recovery have sustained interest in implant arthroplasty. Early implant designs were associated with high rates of loosening, instability, osteolysis, and failure, limiting their widespread adoption. Over the past five decades, advances in implant design, biomaterials, fixation strategies, and articulation mechanics have substantially improved the reliability of total trapeziometacarpal arthroplasty. Contemporary studies demonstrate improved implant survivorship and favorable clinical outcomes, with many of the benefits of arthroplasty realized during the early postoperative period, including accelerated recovery, earlier improvements in pain and function, faster return to work, and preservation of pinch strength. Patient selection has also evolved with greater recognition of the importance of trapezial morphology and a reassessment of traditional contraindications such as concomitant scaphotrapeziotrapezoid osteoarthritis. This Current Concepts review summarizes the evolution of total trapeziometacarpal arthroplasty and examines contemporary evidence regarding patient selection, outcomes, complications, revision strategies, and current surgical considerations.