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Introduction: In a recent systematic review of the current literature we concluded that at this time no surgical procedure is superior over another in the treatment of TMC OA. However, given the lack of high level RCT’s on TMC arthrodesis and total joint prostheses (TJP) and based on good results of these techniques in studies with less methodological quality, we postulated that there could be differences between the various surgical procedures. Therefore, we conducted two high level RCT’s: 1. TMC arthrodesis (plate and screws) compared with trapeziectomy with LRTI. 2. TJP (Guepar prosthesis) compared with trapeziectomy.

Material and Methods: After approval of the scientific committee women above 40 years of age with stage II or III primary TMC OA were enrolled in our RCT’s between 2008 en 2011. Both questionnaires (DASH and PRWHE), functional outcomes (strength and dexterity)as well as patient global assessment and complications were assessed before surgery, at 3 months and 1 year after surgery.

Results: Arthrodesis versus trapeziectomy with LRTI: So far 15 patients in the arthrodesis group and 18 patients in the trapeziectomy with LRTI group fulfilled the 12 month follow-up. In both groups, DASH and PRWHE scores improved significantly after 12 months (p < .001), but we found no significant differences between the groups. Furthermore, strength, dexterity and overall satisfaction were similar between the groups. However, we found that a significant larger percentage of patient with trapeziectomy with LRTI would have the same surgery again, (90% vs. 55% for the arthrodesis group (p = .022)). Additionally, we also found a statistically significant difference in complications between the groups. We observed only 5 complications in the trapeziectomy with LRTI group while in the arthrodesis group 15 complications were reported (p = .039).

TJP versus trapeziectomy: 27 patients in the trapeziectomy group and 28 patients in the TJP group fulfilled the 3 months follow-up. Again, DASH and PRWHE scores were significantly improved after 3 months (p < .001) and no differences were found between groups. In addition, strength, dexterity, patient global assessment, and complications were also similar between both groups.

Discussion: Based on the preliminary results showing significant differences in patient global assessment and complication rates, we do not recommend routine use of TMC arthrodesis in the treatment of TMC OA. Furthermore, the lack of a difference between TJP compared with trapeziectomy in outcomes after 3 months, indicates no faster recovery of TMC OA using TJP.