This prospective case series evaluated 110 IVORY® total trapeziometacarpal prostheses in 95 patients over a minimum 10-year follow-up. It reports implant survival, pain relief, functional recovery, and radiographic stability for a second-generation uncemented TMC arthroplasty. The study addresses whether total joint replacement can match the long-term durability of trapeziectomy while preserving thumb length and strength.
The traditional teaching has been that trapeziectomy is the gold standard for TMC arthritis — reliable pain relief, but at the cost of thumb shortening and some permanent pinch weakness. Total TMC arthroplasty was viewed with skepticism, partly because early cemented implants had high complication rates and were restricted to elderly, low-demand women.
This series establishes that the second-generation uncemented IVORY® prosthesis can achieve 95% survival at 10 years with zero loosening, near-complete pain relief by 3 months, and full preservation of thumb length. Outcomes that match or exceed trapeziectomy on every functional metric.
When counseling patients on surgical options, use this data to frame the risk-benefit discussion concretely: for patients over 60 in non-manual work, TMC arthroplasty offers faster recovery and preserved thumb architecture with very low implant failure risk. For patients under 60 or with high-intensity manual demands, the failure risk is significantly higher (p = 0.03). Warn them explicitly and ensure they understand that secondary trapeziectomy remains a reliable salvage if the prosthesis fails.
The authors note that STT arthritis and Dell Stage IV with trapezium height <8 mm are contraindications to arthroplasty. Always assess these radiographically before offering joint replacement.
This prospective case series evaluated 110 IVORY® total trapeziometacarpal prostheses in 95 patients over a minimum 10-year follow-up. It reports implant survival, pain relief, functional recovery, and radiographic stability for a second-generation uncemented TMC arthroplasty. The study addresses whether total joint replacement can match the long-term durability of trapeziectomy while preserving thumb length and strength.
The traditional teaching has been that trapeziectomy is the gold standard for TMC arthritis — reliable pain relief, but at the cost of thumb shortening and some permanent pinch weakness. Total TMC arthroplasty was viewed with skepticism, partly because early cemented implants had high complication rates and were restricted to elderly, low-demand women.
This series establishes that the second-generation uncemented IVORY® prosthesis can achieve 95% survival at 10 years with zero loosening, near-complete pain relief by 3 months, and full preservation of thumb length. Outcomes that match or exceed trapeziectomy on every functional metric.
When counseling patients on surgical options, use this data to frame the risk-benefit discussion concretely: for patients over 60 in non-manual work, TMC arthroplasty offers faster recovery and preserved thumb architecture with very low implant failure risk. For patients under 60 or with high-intensity manual demands, the failure risk is significantly higher (p = 0.03). Warn them explicitly and ensure they understand that secondary trapeziectomy remains a reliable salvage if the prosthesis fails.
The authors note that STT arthritis and Dell Stage IV with trapezium height <8 mm are contraindications to arthroplasty. Always assess these radiographically before offering joint replacement.