Gervis (1949) is the first published description of complete trapezium excision for trapeziometacarpal osteoarthritis. It asks whether simple excision arthroplasty can reliably relieve pain and restore thumb function without the mobility sacrifice of arthrodesis. This 13-patient case series is the foundational paper for a procedure still performed today.
When Gervis published in 1949, Forestier (1927) had described trapeziometacarpal OA in detail but offered only palliative treatment. Arthrodesis existed but sacrificed mobility and required prolonged immobilization — a poor trade for a joint whose primary purpose is opposition and grasp.
This paper is why simple trapezium excision remains a viable standalone procedure. For elderly or lower-demand patients who want pain relief without ligament reconstruction, the Gervis series is the evidence base. Two technical principles he identified appear in every modern operative description: protect the radial artery in the anatomical snuff box, and stay on bone during palmar dissection to avoid the flexor carpi radialis.
Ligament reconstruction with tendon interposition (LRTI), popularized by Burton and Pellegrini in 1986, was built on this foundation. Randomized trials since have repeatedly shown that simple excision performs comparably to LRTI at medium-term follow-up. Which means Gervis's original operation has never been clearly surpassed in outcomes data.
Gervis (1949) is the first published description of complete trapezium excision for trapeziometacarpal osteoarthritis. It asks whether simple excision arthroplasty can reliably relieve pain and restore thumb function without the mobility sacrifice of arthrodesis. This 13-patient case series is the foundational paper for a procedure still performed today.
When Gervis published in 1949, Forestier (1927) had described trapeziometacarpal OA in detail but offered only palliative treatment. Arthrodesis existed but sacrificed mobility and required prolonged immobilization — a poor trade for a joint whose primary purpose is opposition and grasp.
This paper is why simple trapezium excision remains a viable standalone procedure. For elderly or lower-demand patients who want pain relief without ligament reconstruction, the Gervis series is the evidence base. Two technical principles he identified appear in every modern operative description: protect the radial artery in the anatomical snuff box, and stay on bone during palmar dissection to avoid the flexor carpi radialis.
Ligament reconstruction with tendon interposition (LRTI), popularized by Burton and Pellegrini in 1986, was built on this foundation. Randomized trials since have repeatedly shown that simple excision performs comparably to LRTI at medium-term follow-up. Which means Gervis's original operation has never been clearly surpassed in outcomes data.