Total joint arthroplasty versus resection-interposition arthroplasty for thumb carpometacarpal arthritis: a randomized controlled trial


  • Sebastian M Klim Department for Orthopaedics and Trauma, Medical University of Graz, Graz
  • Reingard Glehr Institute of General Practice and Evidencebased Health Services Research, Medical University of Graz, Austria
  • Armin Graef Department for Orthopaedics and Trauma, Medical University of Graz, Graz
  • Florian Amerstorfer Department for Orthopaedics and Trauma, Medical University of Graz, Graz
  • Andreas Leithner Department for Orthopaedics and Trauma, Medical University of Graz, Graz
  • Mathias Glehr Department for Orthopaedics and Trauma, Medical University of Graz, Graz



Arthroplasty, Articular cartilage, Implants, Osteoarthrosis, RCT


Background and purpose: Thumb carpometacarpal (TCMC) osteoarthritis is a common condition that causes pain and functional limitations. We compared the outcomes of 2 surgical procedures for TCMC osteoarthritis, the Epping resection-suspension arthroplasty and the double-mobility TCMC prosthesis, and focused on pain relief, functional outcomes, and patient quality of life.
Patients and methods: Over a 7-year period a randomized controlled trial including 183 cases of TCMC osteoarthritis was conducted comparing a double mobility TCMC prosthesis (Moovis, Stryker, Kalamazoo, MI, USA) with the Epping resection-suspension arthroplasty. Pre- and postoperative examinations included the range of motion (ROM), SFMcGill score, visual analogue scale (VAS), the disabilities of the arm, shoulder and hand questionnaire (DASH), and the hospital anxiety and depression scale (HADS).
Results: At the 6-week postoperative follow-up, significant differences were found in VAS: Epping median 4.0 (interquartile range [IQR] 2.0–5.0) vs. TCMC prosthesis 2.0 (IQR 0.25–4.0), p = 0.03, effect size (area under the curve [AUC]) 0.64 (95% confidence interval [CI] 0.55–0.73), in DASH score: Epping 61 (IQR 43–75) vs. TCMC prosthesis 45 (IQR 29–57), p < 0.001, AUC 0.69 (CI 0.61– 0.78), and in radial abduction: Epping 55 (IQR 50–60) vs. TCMC prosthesis 62 (IQR 60–70), p = 0.001, AUC 0.70 (CI 0.61–0.79). No significant group differences were found at the 6- and 12-months follow-up. During the follow-up period, 3 of 82 prostheses had to be revised but there was no revision in the Epping group.
Conclusion: The double mobility TCMC prosthesis had superior outcomes compared with the Epping procedure at 6 weeks; however, there were no significant differences in outcomes at 6 months and 1 year postoperatively. The implant survival rate of 96% after 12 months was acceptable


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Epping W, Noack G. (Surgical treatment of the saddle joint arthrosis). Handchir Mikrochir Plast Chir 1983; 15(3): 168.

Wittemann M, Demir E, Sauerbier M, Germann G. (The Epping resection-suspension arthroplasty procedure: a standard procedure in the operative treatment of trapeziometacarpal osteoarthrosis?). Handchir Mikrochir Plast Chir 2002; 34(1): 49. doi: 10.1055/s-2002-22108. DOI:

Krein R, Richter M, Brüser P. (Does Epping resection arthroplasty lead to loss of hand strength? A prospective study). Handchir Mikrochir Plast Chir 2001; 33(3): 171. doi: 10.1055/s-2001-15125. DOI:

Klein S M, Wachter K, Koller M, Vykoukal J, Geis S, Dolderer J H, et al. Long-term results after modified Epping procedure for trapeziometacarpal osteoarthritis. Arch Orthop Trauma Surg 2015; 135(10): 1475. doi: 10.1007/s00402-015-2307-6. DOI:

Liu Q, Xu B, Lyu H, Lee J H. Differences between simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 142(6): 987. doi 10.1007/s00402-020-03707-w DOI:

Lemoine S, Wavreille G, Alnot J Y, Fontaine C, Chantelot C. Second generation GUEPAR total arthroplasty of the thumb basal joint: 50 months follow-up in 84 cases. Orthop Traumatol Surg Res 2009; 95(1): 63. doi: 10.1016/j.otsr.2008.06.001. DOI:

Robles-Molina M J, Lopez-Caba F, Gomez-Sanchez R C, Cardenas-Grande E, Pajares-Lopez M, Hernandez-Cortes P. Trapeziectomy with ligament reconstruction and tendon interposition versus a trapeziometacarpal prosthesis for the treatment of thumb basal joint osteoarthritis. Orthopedics 2017; 40(4): e681. doi 10.3928/01477447-20170503-03. DOI:

Vandenberghe L, Degreef I, Didden K, Fiews S, De Smet L. Long term outcome of trapeziectomy with ligament reconstruction/tendon interposition versus thumb basal joint prosthesis. J Hand Surg Eur 2013; 38(8): 839. doi 10.1177/1753193412469010. DOI:

Cebrian-Gomez R, Lizaur-Utrilla A, Sebastia-Forcada E, Lopez-Prats F A. Outcomes of cementless joint prosthesis versus tendon interposition for trapeziometacarpal osteoarthritis: a prospective study. J Hand Surg Eur 2019; 44(2): 151. doi 10.1177/1753193418787151. DOI:

Ulrich-Vinther M, Puggaard H, Lange B. Prospective 1-year follow-up study comparing joint prosthesis with tendon interposition arthroplasty in treatment of trapeziometacarpal osteoarthritis. J Hand Surg Am 2008; 33(8): 1369. doi: 10.1016/j.jhsa.2008.04.028. DOI:

Jurča J, Němejc M, Havlas V. (Surgical treatment for advanced rhizarthrosis. comparison of results of the Burton–Pellegrini technique and trapeziometacarpal joint arthroplasty). Acta Chir Orthop Traumatol Cech 2016; 83(1): 27.

Kaszap B, Daecke W, Jung M. High frequency failure of the Moje thumb carpometacarpal joint arthroplasty. J Hand Surg Eur 2012; 37(7): 610. doi: 10.1177/1753193412454252. DOI:

Pérez-Ubeda M J, García-López A, Marco Martinez F, Junyent Vilanova E, Molina Martos M, López-Duran Stern L. Results of the cemented SR trapeziometacarpal prosthesis in the treatment of thumb carpometacarpal osteoarthritis. J Hand Surg Am 2003; 28(6): 917. doi: 10.1016/s0363-5023(03)00378-2. DOI:

Medical University of Graz. Randomizer. (Accessed November 1, 2014).

McCormack H M, Horne D J, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med 1988; 18(4): 1007. doi :10.1017/s0033291700009934. DOI:

Kapandji A. (Clinical test of apposition and counter-apposition of the thumb). Ann Chir Main 1986; 5(1): 67. doi 10.1016/s0753-9053(86)80053-9. DOI:

Hudak P L, Amadio P C, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) (corrected). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29(6): 602. doi: 10.1002/(sici)1097-0274(199606)29:6<602::Aid-ajim4>3.0.Co;2-l. DOI:<602::AID-AJIM4>3.0.CO;2-L

Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1(3): 277, 1975, doi: 10.1016/0304-3959(75)90044-5 DOI:

Zigmond A S, Snaith R P. The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6): 361, 1983, DOI:

Huang K, Hollevoet N, Giddins G. Thumb carpometacarpal joint total arthroplasty: a systematic review. J Hand Surg Eur 2015 ; 40(4): 338. doi: 10.1177/1753193414563243. DOI:

Hess D E, Drace P, Franco M J, Chhabra A B. Failed thumb carpometacarpal arthroplasty: common etiologies and surgical options for revision. J Hand Surg Am 2018; 43(9): 844. doi: 10.1016/j.jhsa.2018.03.052. DOI:

Wachtl S W, Guggenheim P R, Sennwald G R. Cemented and non-cemented replacements of the trapeziometacarpal joint. J Bone Joint Surg Br 1998; 80(1): 121. doi: 10.1302/0301-620x.80b1.7941. DOI:

De Smet L, Sioen W, Spaepen D, van Ransbeeck H. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg 2004; 9(1): 5. doi: 10.1142/s0218810404001942. DOI:

Regnard P J. Electra trapezio metacarpal prosthesis: results of the first 100 cases. J Hand Surg Br 2007; 31: 621. doi: 10.1016/j.jhsb.2006.05.019. DOI:

Hansen T B, Stilling M. Equally good fixation of cemented and uncemented cups in total trapeziometacarpal joint prostheses: a randomized clinical RSA study with 2-year follow-up. Acta Orthop 2013; 84(1): 98. doi: 10.3109/17453674.2013.765625. DOI:

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How to Cite

Klim, S. M., Glehr, R., Graef, A., Amerstorfer, F., Leithner, A., & Glehr, M. (2023). Total joint arthroplasty versus resection-interposition arthroplasty for thumb carpometacarpal arthritis: a randomized controlled trial. Acta Orthopaedica, 94, 224–229.





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