The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on artificial trapeziometacarpal (TMC) joint replacement for osteoarthritis.


Osteoarthritis of the hand joints is a common condition that deteriorates over time, although severity of symptoms, rate of deterioration and functional effects are variable. Common sites of osteoarthritis that may be suitable for artificial implants include the trapeziometacarpal (TMC) joint of the thumb (also called the carpometacarpal joint), and metacarpophalangeal and interphalangeal joints of the fingers and thumb.

Conservative treatments for osteoarthritis of the hand include anti-inflammatory and analgesic medication, and steroid injections. Other treatments for more severe disease include joint excision without replacement (excision arthroplasty), native graft arthroplasty (the patient's own tissue is interposed in the space left after joint excision) and fusion of the joint (arthrodesis).

To insert an artificial TMC joint, a general anaesthetic is usually used and a tourniquet is applied to the affected arm to maintain a blood-free operation site. An incision is made over the disease joint and the joint is removed. An artificial joint, typically made of a silicone based material, is inserted in place of the original joint. Local anaesthetic may be injected into the surgical area or into the arm at the end of the operation. The incisions are sutured and a splint is applied.

Coding recommendations

W43.- Total prosthetic replacement of other joint using cement


W44.- Total prosthetic replacement of other joint not using cement


W45.- Other total prosthetic replacement of other joint

A site code is assigned depending on which joint is replaced, either Z82.3 Carpometacarpal joint of thumb or Z82.4 Carpometacarpal joint of finger.