Trapeziectomy with LRTI or Dual-Mobility Prosthesis for Thumb Carpometacarpal Arthritis: A Systematic Review with Considerations for Elderly Patients over 70 Years of Age

<b>Background:</b> Thumb carpometacarpal (CMC) arthritis affects up to 25% of women and 8% of men over 70 years of age, significantly compromising their activities of daily living. With the rapid growth of the elderly population globally and their specific clinical needs, understanding optimal surgical treatment for this age group is crucial. This systematic review compares trapeziectomy with ligament reconstruction and tendon interposition (LRTI) versus dual-mobility prosthesis for treating thumb CMC arthritis in elderly patients over 70 years old. <b>Methods:</b> A systematic search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library for studies published up to August 2025. Studies that directly compared both techniques were included, with subgroup analyses performed for elderly patients over 70 years of age when data were available. Primary outcomes included pain relief, functional improvement, grip and pinch strength, complications, and patient satisfaction. <b>Results:</b> Five studies met the inclusion criteria for direct comparison of both techniques, encompassing 313 patients (324 thumbs). While none exclusively focused on patients over 70, elderly patients represented 25-41% of study populations. Due to the absence of age-stratified data in the original studies, our analysis encompasses all age groups with specific considerations for elderly patients where identifiable. Dual-mobility prostheses demonstrated faster pain relief and earlier functional improvement, particularly within the first 3-6 months postoperatively. Prostheses consistently provided superior grip and pinch strength outcomes throughout follow-up periods. Both procedures effectively preserved thumb function, but prostheses better maintained thumb length and metacarpophalangeal stability. While complication rates were comparable, LRTI complications were typically minor and self-limiting, whereas prosthesis complications, though rare, could potentially require revision surgery. Longer-term follow-up data (>3 years) remain limited, particularly regarding implant degradation and adverse local tissue reactions. <b>Conclusions:</b> Both procedures effectively treat thumb CMC arthritis in elderly patients, with distinct advantages. Dual-mobility prostheses offer faster recovery, enhanced strength, and better thumb length preservation, making them potentially advantageous for elderly patients prioritizing rapid functional recovery. Trapeziectomy with LRTI provides reliable long-term pain relief with fewer serious complications, making it suitable for patients with poor bone quality or significant comorbidities. Treatment selection should be individualized based on patient characteristics, functional demands, and surgeon expertise. Future research specifically focusing on elderly populations with longer follow-up periods (>5 years) is critically needed to provide stronger evidence for this growing demographic and to better understand long-term implant performance.