Place of Trapezio-Metacarpal Prosthesis in Surgical Treatment of Carpo-Metacarpal Arthritis

Trapezio-metacarpal prosthesis (TMP) is one of the modern options for surgical treatment of carpo-metacarpal arthritis in France. In comparison with trapeziectomies, justification is essentially biomechanical (conservation of centers of rotation, and action of the muscles), and also clinical, with good quality of results.First cases appeared in the seventies based on principle of « ball and sockets », but high level of failure diminished their indications, leading to important modifications: modularity, number of sizes (stem, neck, cup), type of fixation, center of rotation, shape of the cup. A new generation appeared in the nineties with clinical results similar to trapeziectomies. Series of different types of prosthesis are published with significate number of cases and follow-up, especially in French literature, with a failure rate (instability, loosening) similar to those of other arthroplasties. More recently the principle of double mobility has been applied, for diminishing number of late complications.For the surgeon it is important to analyze first the patient, especially his age and level of physical activity. He must be informed on advantages of the method, but also the limits and the possibility of surgical revision. Orthopedic or Hand surgeon has to utilize referenced type of prosthesis, and experienced in that technique.