Arthroscopic Hemi-Trapeziectomy with Interposition for First Carpometacarpal Joint Arthritis: A Technique Guide and Midterm Analysis of Subjective Patient Outcomes

Abstract Early arthritis of the first carpometacarpal joint (CMCj) lacks a universal surgical treatment paradigm. Open techniques are often effective but require lengthy recovery and can be difficult to revise if symptoms recur. Arthroscopic hemi-trapeziectomy with interposition (HTI) has been described, but its durability and outcomes in comparison to open techniques are yet to be elucidated. This work describes a technique of arthroscopic HTI and compares patient-reported outcome measures (PROMs) of patients undergoing arthroscopic HTI to those following trapeziectomy with flexor carpi radialis ligament reconstruction and tendon interposition (LRTI), as well as adductor pollicis longus (APL) suspensionplasty. A retrospective review was performed for patients undergoing surgical management of first CMCj arthritis between October 1, 2018, and October 1, 2024. Baseline demographics were collected, and preoperative radiographs were graded using the Eaton–Littler classification. Patients undergoing HTI had postoperative protocols including 2 weeks of immobilization, followed by 6 weeks of splinting and physiotherapy, whereas open techniques underwent 6 weeks of cast immobilization, followed by 6 weeks of splinting and physiotherapy. Patients were contacted postoperatively to complete PROMs, including Visual Analog Scale (VAS) pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and hand subjective value (HSV). Patients were also asked if they would undergo the same procedure again and to rank satisfaction on a 5-point ordinal scale (1: very dissatisfied, 2: dissatisfied, 3: neutral, 4: satisfied, 5: very satisfied). Continuous variables were compared between groups using the independent-samples Kruskal–Wallis test, and binary values were compared using chi-square analysis with significance set at p < 0.05. A total of 57 patients were included in this review. Of these patients, 21 underwent arthroscopic HTI. Average Eaton–Littler score was 2.2 (± 0.94), and average follow-up was 29.7 (± 13.2) months. PROMs were favorable, with an average VAS pain of 0.9 (± 1.6), QuickDASH of 7.1 (± 8.8), and HSV of 87.8 (± 14.6). About 91% of patients reported that they would do the procedure again, with 17 patients being very satisfied with their outcome, 2 were satisfied, and 2 were either neutral or dissatisfied (median ordinal score: 5/5). These results were comparable to the 14 patients who underwent trapeziectomy and LRTI (median ordinal score: 4/5) and the 22 patients who underwent trapeziectomy and APL suspensionplasty (median ordinal score: 5/5). Average Eaton–Littler score for these groups was 2.8 (± 0.85) and 2.7 (± 0.71), respectively. Compared with HTI, there was no difference between groups for VAS pain at rest (p = 0.204), QuickDASH (p = 0.213), or HSV (p = 0.724). Furthermore, there was no significant difference among groups when evaluating the proportion of patients who would undergo the same procedure again (p = 0.936). Arthroscopic HTI produced promising PROMs at midterm analysis and was perceived favorably despite a less restrictive postoperative protocol compared with conventional operative techniques. Preservation of soft tissues, shorter recovery, and potential for future revision with recurrence of symptoms make this technique an attractive addition to the armamentarium of surgical interventions for CMCj arthritis. IV.