Trapeziectomy (thumb base surgery)

What is a trapeziectomy?

A trapeziectomy is an operation to treat painful arthritis at the base of the thumb. The surgeon removes a small bone in the wrist called the trapezium, which forms part of the joint at the base of the thumb (the carpometacarpal or CMC joint). Removing the worn bone stops the painful bone-on-bone grinding.

It is usually offered for thumb base osteoarthritis when pain, weakness and loss of function have not improved with hand therapy, splints, painkillers and sometimes steroid injections. The condition is common, especially in women after the menopause.

Some surgeons remove the trapezium alone, while others add a step to support the thumb, such as reconstructing a ligament and tucking in a strip of tendon (called LRTI), or using a temporary wire or a suture button. Large studies have not shown one of these add-ons to be clearly better than simple removal, so techniques vary between surgeons. Trapeziectomy reliably reduces pain for most people, but the thumb may feel a little weaker or shorter, and the early recovery is slow.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Surgery vs other options for thumb base arthritis

Surgery is usually considered only after non-surgical options have been tried. Your surgeon will explain which operation suits your joint and hand use.

Preparing for your surgery

• See the operating surgeon, who will examine your thumb, review X-rays and confirm that surgery is the right step after other treatments.
• Have a pre-operative assessment to check your general health and any anaesthetic considerations.
• Tell the team about all medicines, especially blood thinners, which may need pausing.
• Arrange a lift home, as you will not be able to drive immediately and your hand will be bandaged.
• Plan for a cast or splint for around six weeks and arrange help with tasks that need two hands.
• Set up your home so everyday items are easy to reach with one hand, and stock easy meals.
• Ask about hand therapy after surgery, as exercises are an important part of recovery.

What happens

A trapeziectomy is usually done as a day case under a general anaesthetic or a regional anaesthetic that numbs the whole arm.

The surgeon makes a small cut over the base of the thumb, removes the trapezium bone and, depending on the technique, may reconstruct a ligament, place a strip of tendon, or use a temporary wire or button to support the thumb. The wound is closed with stitches and your hand and thumb are supported in a cast or splint.

The operation usually takes around 45 to 90 minutes. Most people go home the same day with the hand bandaged and a plan for keeping it raised to reduce swelling.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The biggest things to expect are a slow early recovery — pain and swelling can last for some months — and that the thumb may feel slightly weaker or shorter afterwards, even when the operation goes well. Ask your surgeon which technique they use and why, and how long they expect your recovery to take.

Published figures to discuss

Most people do well after a trapeziectomy, but recovery is slow and a minority have ongoing pain or weakness. Techniques and studies vary, so exact complication rates are less stable than for hip or knee replacement. The figures below are broad anchors from reviews and should be discussed in your own context.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from a trapeziectomy is slower than many people expect. Pain relief is usually good in the long run, but the first few months involve a cast or splint, hand therapy and gradual rebuilding of strength.

• Pain and swelling that can last several months before settling
• A stiff thumb and hand that loosen with exercises
• Weak pinch and grip early on that build slowly
• A scar that is firm and sensitive at first and softens over time
• Gradual, steady progress rather than a quick fix

Aftercare

• Keep your hand raised in the early days to reduce swelling.
• Take pain relief as advised, as discomfort can be more than expected at first.
• Wear your cast or splint as instructed and keep it clean and dry.
• Do your hand therapy exercises and attend therapy appointments, as these strongly affect recovery.
• Once the wound is healed, massage the scar as advised to keep it supple.
• Avoid heavy pinch and gripping until your surgeon or therapist says it is safe (often at least 10–12 weeks).
• Do not drive until you have safe control of the hand and your surgeon agrees.

• Cast or splint instructions understood
• Pain relief collected and a plan for taking it
• Hand therapy appointments booked
• Help arranged for two-handed tasks at home
• Easy meals and one-handed kitchen setup ready
• Lift home and to early appointments arranged
• Clinic's contact number saved for problems

Scars and how they heal

There is a small scar at the base of the thumb. It is firm and can feel sensitive at first, and usually softens and fades over several months. Gentle scar massage once the wound has healed, as advised by your therapist, helps keep the skin moving freely.

⚠ Get urgent help if…

• Increasing redness, heat, swelling or discharge from the wound (possible infection)
• A fever or feeling generally unwell after surgery
• Severe or rapidly worsening pain, especially out of proportion to the surgery
• A hand or thumb that becomes very swollen, shiny, stiff and painful (possible complex regional pain syndrome)
• Numbness, tingling or loss of movement that is new or worsening
• A cast or splint that feels too tight, with throbbing or colour change in the fingers

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result usually means much less pain at the thumb base and an easier time with everyday tasks once the hand has fully recovered. Most people are satisfied in the long term.

Results take time — pain and swelling can last for months and full strength often takes six months or more. The thumb may feel slightly weaker or shorter than before, which is normal and usually does not stop everyday activities. Surgery removes the worn joint, so the grinding pain should not return.

Trapeziectomy is a durable operation, and the relief it gives is usually long-lasting because the worn bone has been removed. Some settling of the thumb metacarpal into the gap is expected and does not always cause problems. A small number of people have ongoing aching or weakness, particularly with heavy use, and very occasionally further surgery is considered.

Combining with other procedures

Thumb base arthritis sometimes occurs alongside other hand problems, such as carpal tunnel syndrome or trigger finger, and these are occasionally treated at the same time if appropriate. Your surgeon will discuss whether anything else needs doing.

Follow-up & long-term care

You will be reviewed to check the wound and remove stitches, and any temporary wire is removed at the planned time. Hand therapy continues for some weeks to months. Report any signs of infection, severe pain or unusual swelling promptly.

• Keep up the strengthening and movement exercises your hand therapist gives you.
• Continue scar massage as advised until the scar has settled.
• Build up heavy gripping and pinching gradually rather than suddenly.
• Use joint-protection techniques and supportive aids for demanding tasks if recommended.

Revision and secondary surgery reality

• Some settling of the thumb metacarpal into the gap is expected and does not always cause symptoms.
• A small number of people have ongoing aching or weakness, occasionally leading to further assessment or surgery.
• If a temporary wire or button was used, a further minor procedure may be needed to remove it.
• Revision after trapeziectomy is uncommon but more complex than the first operation.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• A clear plan for cast or splint use and when it changes.
• Referral to hand therapy with a structured exercise and scar-care programme.
• A named contact and a number to call for wound, pain or swelling concerns.
• Planned follow-up to remove stitches and any wire and to check progress.
• Prompt assessment if infection or unusual, worsening pain develops.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The operating surgeon's fee and the anaesthetist's fee
• Theatre and day-case facility charges
• The technique used (simple removal, ligament reconstruction, wire or button) and any device
• Hand therapy sessions after surgery, which are an important part of recovery
• Follow-up appointments and removal of any temporary wire
• Splints or casts provided
• Cover for managing complications if they occur

• The surgeon's fee and the anaesthetist's fee
• Theatre, day-case charges and any device or wire used
• How many hand therapy sessions are included and for how long
• Follow-up appointments and removal of any temporary wire
• What happens, and who pays, if a complication occurs
• The cancellation policy
• Whether further surgery would be covered if the first operation did not relieve the pain

On the NHS? Trapeziectomy is commonly funded by the NHS when thumb base arthritis is painful and has not improved with hand therapy, splints, painkillers and injections; private care is sometimes used for a shorter wait or choice of surgeon.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Which technique do you use, and why do you prefer it for me?
• How long do you expect my recovery and time off work to take?
• How much pinch and grip strength am I likely to get back?
• What are the chances of ongoing pain or weakness afterwards?
• Would a joint fusion or another option suit my hand use better?
• What hand therapy will I need, and how soon does it start?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for trapeziectomy (thumb base surgery)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Osteoarthritis Cambridge University Hospitals NHS — Information after trapeziectomy surgery South Tees Hospitals NHS — Advice and exercises following trapeziectomy Trapeziectomy vs CMC arthroplasty — comparative outcomes review (PMC) BSSH — Evidence-based management of thumb base osteoarthritis Trapeziectomy and thumb CMC arthroplasty network meta-analysis

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.