No, they are not the same procedure—trapeziectomy with tendon interposition is a more extensive operation than trapeziectomy alone.
Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) combines trapezium removal with additional soft tissue reconstruction, whereas simple trapeziectomy only removes the trapezium bone. These represent different surgical approaches for thumb CMC osteoarthritis, with LRTI being the more complex procedure.
Key Procedural Differences
Simple Trapeziectomy
- Removal of the trapezium bone only
- No additional reconstruction
- Shorter operative time
- Less tissue manipulation
Trapeziectomy with LRTI (Tendon Interposition)
- Removal of trapezium bone
- Harvesting of tendon (typically flexor carpi radialis)
- Ligament reconstruction through bone tunnels
- Tendon interposition into the trapezial space
- Significantly longer operative time 1
Clinical Evidence Against Combined Procedures
The evidence actually suggests avoiding the combined approach. EULAR guidelines explicitly state that combining trapeziectomy with ligament reconstruction and tendon interposition offers no advantages over simple trapeziectomy alone, but results in a 2.12-fold higher complication rate (RR = 2.12,95% CI 1.24-3.60) 1.
Complications More Common with LRTI Include:
- Tendon rupture or adhesion
- Scar tenderness
- Sensory changes
- Neurological complications
- Instability
- Complex regional pain syndrome 1
Outcomes Comparison
Both procedures provide similar results for:
- Pain relief (ES = 0.17,95% CI -0.57 to 0.24)
- Functional improvement (ES = 0.03,95% CI -0.37 to 0.44)
- Long-term patient satisfaction 1
Recent research confirms these findings, with studies showing comparable VAS scores and QuickDASH outcomes between simple trapeziectomy and LRTI procedures 2, 3.
Clinical Recommendation
For severe thumb base osteoarthritis refractory to conservative treatment, simple trapeziectomy should be preferred over trapeziectomy with LRTI 1. The guideline evidence is clear: "The combination of two surgical procedures appears to offer no advantages but a higher complication rate and therefore should be avoided" 1.
When to Consider Each Approach:
- Simple trapeziectomy: First-line surgical option for most patients with severe thumb CMC OA
- LRTI: No clear indication based on current evidence; historically performed but not supported by comparative trials
- Arthrodesis: Consider for younger, high-demand workers requiring maximum strength 4, 3
Important Caveat
While newer modifications like suture suspensionplasty show promise with less subsidence and shorter operative times 5, 6, the fundamental principle remains: adding tendon interposition to trapeziectomy increases complexity and complications without improving outcomes. The procedures are definitively different, and the simpler approach is clinically superior.