What is a trapeziectomy?

A trapeziectomy is the removal of a small bone in your wrist called the trapezium. Your arm may be numbed with a regional anesthetic, or you may have a general anesthetic. Your surgeon will make a small incision on the back of the hand at the base of the thumb, removing your trapezium. They will reconstruct a ligament that attaches your thumb to your wrist using a tendon that runs over the trapezium.

Your surgeon will stitch your skin back together. A trapeziectomy takes about 60-90 minutes. Your hand may have a bandage or plaster cast. To reduce swelling, you will be encouraged to elevate your hand above your heart using a sling or pillow. Gentle finger movement will also help prevent stiffness.

What is the aim of Trapeziectomy?

The primary indication for trapeziectomy is the failure to relieve pain in the joint at the base of the thumb that worsens with motion or activity.

Thumb arthritis is one of the most common complaints treated with a trapeziectomy when conservative treatments fail to remove the pain and discomfort. The following interventions have been attempted and do not offer adequate relief:

Nonsteroidal anti-inflammatory drugs
Corticosteroid injections
Bracing or splinting
Physical therapy
Occupational therapy

How to prepare for the surgery?

A trapeziectomy is usually treated as an outpatient procedure, and thus you will be able to return home on the same day of the surgery. It is not recommended to drive post-surgery, so make sure to arrange a ride.

You will be asked to hold certain medications or supplements on several days before the surgery to avoid their action of enhancing bleeding or interfering with anesthesia. Some examples include the following:

Anticoagulants ("blood thinners"): Generally 3 to 5 days prior to surgery3
Monoamine oxidase inhibitors (MAOIs): Typically 2 weeks before surgery4
Nonsteroidal anti-inflammatory drugs (NSAIDs): Generally 7 to 10 days prior to surgery

You will also be advised to stop eating about midnight on the day before your surgery in case you will vomit when under anesthesia that might result in aspiration.

Follow your surgeon's pre-operative guidelines to avoid complications or a potential postponement of your surgery.

What happens before the trapeziectomy surgery?

You will be brought to a pre-op room when you reach the clinic where you will:

Put on your surgical gown.
Record your vital signs.
Adhesive probe has been put on your chest for monitoring heart rate on the electrocardiogram machine.
A pulse oximeter sensor has been placed on your finger to monitor oxygen levels in your blood.
An intravenous (IV) line has been placed in a vein in our arm to administer anesthesia as well as other medications during the procedure.

Before the surgery, you will meet an anesthesiologist who will tell you which type of anesthesia they are going to use and ensure there is no possible concern, for example, allergies and prior reactions to anesthesia.

Following this, you will be taken on a gurney into the operating table.

What happens during surgery?

Depending on the severity of your arthritis and other factors, you will have general anesthesia (in which you are completely asleep), monitored anesthesia care ("twilight sleep"), or local anesthesia, in which the surgical field is anesthetized and you are awake.

For a trapeziectomy with LRTI, the surgeon typically will:

Make an incision along the top of the metacarpal bone
Use metal retractors to hold open the incision.
Cautiously retract the radial nerve and the radial artery, exposing the trapezium
Now, he cuts it into four sections using a small specialized bone saw.
Then, he removes each section.
Debride and excise any bone spurs associated with the surrounding joints.
Obtain a length of tendon from the tendons of the wrist muscle.
He reconstructs it to attach the metacarpal bone to the trapezium.
Fold and tuck in the ends of your tendon so that it fills the gap where your trapezium used to be. Occasionally, a silicone or metal implant is used instead of taking a tendon from your wrist.
A trapeziectomy generally takes about 60-90 minutes to finish.

What happens after the surgery?

You will be taken to the recovery room after the trapeziectomy. Your vital signs will be monitored until the effect of the anesthesia has been increased to a level that allows you to be discharged from the hospital. Generally, you should be able to leave the hospital within one or two hours of the procedure.

How long is the recovery period for this operation?

You can go home with sutures and a cast on your thumb. To minimize pain and inflammatory response, you will likely be prescribed something like Tylenol (acetaminophen). You may also want to ice and elevate your hand during the first week.

Average recovery time:2
5-10 days: You will likely return to see your surgeon to get sutures removed.
2 to 4 weeks: The cast and sutures will be removed, and a plastic splint will stabilize the wrist. This splint is removed only to bathe or perform post-operative wrist exercises.
4 to 6 weeks: Start physical therapy
6 to 8 weeks: The splint can now be worn at night only. By this stage, you should have more than ample improvement in the movement of the thumb and be able to get back into driving.
6-12 weeks: Heavy tasks may be undertaken. You can return to work
12 weeks to 6 months: Full recovery with the possibility to orient, grasp and pinch though some will still be limited.

Once you have your cast removed, your surgeon will indicate exactly what you should do and how to change dressings and keep the site clean. Avoid applying lotions, creams, or ointments to the area unless your provider instructs you.

How do you take care of your trapeziectomy surgery in the long term?

A trapeziectomy has a high success rate. There are more operating rooms generally reserved elsewhere.

That said, it may be a while before you will return to normal use of your thumb and hand. To maximize your outcome, follow these simple self-care instructions:

In the first few weeks after your trapeziectomy, keep your hand elevated as much as possible. This should help reduce your pain and swelling.

Avoid overexertion, as this will increase your pain and prolong recovery time. Special care should be taken when using your hand for daily activities involving gripping, lifting, pushing, or pulling.

Even when you feel well, always attend all the scheduled medical appointments. This will likely prevent complications or healing issues that you may not notice.

Why Tender Palm Super-Speciality Hospital Trapeziectomy?

Tender Palm Hospital, owned by doctors, is renowned for attracting the most skilled professionals in the country. With the finest Orthopedic surgeons, specialized in Trapeziectomy. Tender Palm stands out as the premier orthopedic hospital in Lucknow, India. Boasting cutting-edge infrastructure and advanced technology, Tender Palm ensures top-notch medical care for its patients.