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Question: The operative treatment of thumb carpometacarpal osteoarthritis has recently undergone a paradigm shift due to excellent early results of CMC-I prosthesis. However, with limited long-term outcomes beyond 10 years and challenges faced by earlier implants generations, careful consideration of their indications remains essential.

This study presents the experiences of a teaching hospital’s hand surgery team over the first 5 years of implanting Touch^® type CMC-I prosthesis, focusing on challenges and complications as “lessons learned”.

Methods: In our clinic, all patients who received a CMC-I prosthesis from 2019 to 2025 were identified. 182 cases were reviewed, involving 134 women, 48 men (average age 62 y, range: 40–80 y). Indications inculuded rhizarthrosis stages 2 or 3. Procedures were mainly outpatient under axillary plexus anaesthesia. Surgical technique involved: dorsal access between EPL and EPB, dorsal capsule resection, circumferential release of the MC I base, removal of trapezial osteophytes and radiologically guided cup drilling. Most cases involved a conical cup and a 15° angled neck. Postoperative care included rigid splinting for a week, followed by standardised therapy with a Comfort Cool brace and mobilisation, and initiation of load-bearing after 6 weeks, if X-ray controls were unremarkable.

Beyond strength and mobility measurements, perioperative and postoperative complications and challenges were recorded. The analysis focuses on “lessons learned” rather than classic CROMs.

Results: Complications occurred in 25.2% (46/182) of the cases. Revision surgery was required in 9.3% (17 patients). Issues included trapezium fractures (3) and dislocations due to incorrect cup placement (5). 4 cases needed a repositioning, while 2 required conversion to RSI arthroplasty. Tendinitis was observed in 22 cases, degeneration of the STT joint in 6 and MCP joint in 3 cases, respectively. Other complications included heterotopic ossifications (3), implant failure including polyethylene fracture (1) and neuropathic pain (8). While most were managed conservatively, some required surgical revision such as a 1st extensor compartment release, MCP joint arthrodesis, reoperation or neurolysis.

Conclusion: Results from the first five years of implanting CMC-I prothesis align with existing literature. We highlight challenges and the surgeon’s progression to guide less experienced colleagues in anticipating and avoiding issues or complications.