Cost–Benefit Analysis in the Surgical Management of Thumb Carpometacarpal Osteoarthritis: Dual-Mobility Total Joint Replacement Versus Trapeziectomy with Ligament Reconstruction and Suspension Arthroplasty

Background: Trapeziometacarpal (TM) osteoarthritis (OA) is a common condition, especially among postmenopausal women, often requiring surgical intervention when conservative treatment fails. In recent years, dual-mobility prostheses have been increasingly used as an alternative to traditional trapeziectomy with suspension arthroplasty. However, limited data exist regarding their comparative cost-effectiveness in public healthcare systems. Purpose: The aim of this study was to compare the cost–benefit ratio and clinical outcomes of two surgical techniques for TM OA: trapeziectomy with suspension arthroplasty and total joint arthroplasty with a dual-mobility prosthesis. Methods: We conducted a retrospective cohort study of 116 hands treated between 2020 and 2024. Patients were divided into two groups based on the surgery they received: trapeziectomy with suspension arthroplasty or implantation of a dual-mobility TM prosthesis. Clinical outcomes were assessed using VAS, DASH, Kapandji score, grip strength, and pinch strength at 12, 36, and 48 months postoperatively. A cost analysis was performed based on hospital reimbursement (Diagnosis-Related Group) and estimated productivity loss. Results: Both techniques yielded significant improvements in pain and function. Patients who were operated on with a prosthesis showed faster recovery and better early outcomes, while the trapeziectomy group had lower direct surgical costs and fewer complications. At 48 months, clinical scores were comparable. The overall cost–benefit ratio favoured trapeziectomy with suspension arthroplasty, while TM prosthesis’s higher costs were justified due to improved short-term functional recovery. Conclusions: Both surgical techniques achieved satisfactory long-term clinical outcomes. The prosthetic option allows for quicker recovery and reduces indirect social costs, while suspension arthroplasty remains more cost-effective for direct costs. These findings highlight the importance of balancing clinical benefit and economic sustainability in surgical decision-making for TM osteoarthritis. Level of Evidence: Level III, retrospective comparative study.