Surgical technique for total prosthetic arthroplasty of the carpo-metacarpal (cmc) joint and results
Seance of wednesday 21 january 2026 (La prothèse trapézo-métacarpienne : de la France aux Etats Unis, un exemple emblématique de la portée internationale de l’Ecole Française)
DOI number : 10.26299/a59d-az14/emem.2026.04.03
Abstract
In 1973, Prof. J.-Y. de La Caffinière proposed, for the first time, the replacement of the arthritic CMC joint with a total prosthesis. His concept, which departed from the double saddle anatomy of this joint, was based on a monobloc metacarpal stem topped with a spherical head, articulating with a polyethylene cup, according to a principle inspired by total hip replacement.
The initial medium-term results, marked by a high rate of early dislocations despite the advent of new prosthetic models, failed to convince the surgical community in the long term. Trapeziectomy then became the standard treatment for several decades. Apart from loosening, the major complication remained instability, leading to the systematic integration of stabilization procedures into the surgical technique: respect for the capsuloligamentous anatomy, various ligamentoplasties.
In the mid-1990s, only a few of us believed that stability should no longer be a matter of ligament reconstruction, but exclusively of prosthetic design and the quality of its implantation.
Based on this premise, several technical principles have become essential when implanting single-mobility prostheses and, more recently, double-mobility prostheses:
• lateral approach, with dorsal or palmar variants;
• complete release of the base of the first metacarpal from its capsuloligamentous attachments;
• synovectomy combined with exhaustive resection of osteophytes (metacarpal beak and trapezium horns);
• absence of any excessive tension in the prosthetic assembly (thickness of osteotomies, depth of stem insertion, length of neck);
• strict adherence to the prosthetic axis (stem, neck, cup) in the trapezo-metacarpal column;
• optimal orientation of the trapezium cup and uniformity of the polyethylene cover in the neutral position of the thumb column;
• soft dressing without plaster cast immobilization of the first web.
The rigorous application of these principles has profoundly changed the medium- and long-term results of CMC prosthetic arthroplasty, with:
• an almost complete disappearance of dislocations;
• a significant decrease in the rate of prosthetic loosening.
A cumulative analysis of more than two decades of international experience now allows us to state that:
• single-mobility prostheses were a fundamental step forward, bringing significant improvements in pain, function, and strength, but their susceptibility to instability and loosening limited their longevity in certain patient profiles;
• Double-mobility prostheses have addressed the previous limitations by providing near-constant stability, better wear control, and a reduction in the rate of revision surgery, with a higher prosthetic survival rate.
These advances explain their gradual and then widespread adoption internationally, including since the end of 2025 in North American centers, which have historically been more reserved about prosthetic arthroplasty of the trapeziometacarpal joint.
The dual-mobility trapeziometacarpal prosthesis can therefore be considered the international benchmark today and one of the most emblematic examples of the global spread of a surgical concept that originated in France.
The initial medium-term results, marked by a high rate of early dislocations despite the advent of new prosthetic models, failed to convince the surgical community in the long term. Trapeziectomy then became the standard treatment for several decades. Apart from loosening, the major complication remained instability, leading to the systematic integration of stabilization procedures into the surgical technique: respect for the capsuloligamentous anatomy, various ligamentoplasties.
In the mid-1990s, only a few of us believed that stability should no longer be a matter of ligament reconstruction, but exclusively of prosthetic design and the quality of its implantation.
Based on this premise, several technical principles have become essential when implanting single-mobility prostheses and, more recently, double-mobility prostheses:
• lateral approach, with dorsal or palmar variants;
• complete release of the base of the first metacarpal from its capsuloligamentous attachments;
• synovectomy combined with exhaustive resection of osteophytes (metacarpal beak and trapezium horns);
• absence of any excessive tension in the prosthetic assembly (thickness of osteotomies, depth of stem insertion, length of neck);
• strict adherence to the prosthetic axis (stem, neck, cup) in the trapezo-metacarpal column;
• optimal orientation of the trapezium cup and uniformity of the polyethylene cover in the neutral position of the thumb column;
• soft dressing without plaster cast immobilization of the first web.
The rigorous application of these principles has profoundly changed the medium- and long-term results of CMC prosthetic arthroplasty, with:
• an almost complete disappearance of dislocations;
• a significant decrease in the rate of prosthetic loosening.
A cumulative analysis of more than two decades of international experience now allows us to state that:
• single-mobility prostheses were a fundamental step forward, bringing significant improvements in pain, function, and strength, but their susceptibility to instability and loosening limited their longevity in certain patient profiles;
• Double-mobility prostheses have addressed the previous limitations by providing near-constant stability, better wear control, and a reduction in the rate of revision surgery, with a higher prosthetic survival rate.
These advances explain their gradual and then widespread adoption internationally, including since the end of 2025 in North American centers, which have historically been more reserved about prosthetic arthroplasty of the trapeziometacarpal joint.
The dual-mobility trapeziometacarpal prosthesis can therefore be considered the international benchmark today and one of the most emblematic examples of the global spread of a surgical concept that originated in France.