Clinical management of trapeziometacarpal joint infections: a European Delphi consensus and literature review

Introduction: Periprosthetic joint infections (PJIs) of the trapeziometacarpal joint of the thumb are rare but challenging complications of arthroplasty. Currently, no hand-specific guidelines exist. This study aimed to develop consensus-based recommendations for their diagnosis and management. Methods: A three-round Delphi process was conducted with seven European hand surgeons experienced in trapeziometacarpal joint arthroplasty. Consensus was defined as ⩾80% agreement (strong) and 65–79% (moderate). A scoping literature review of hand and large-joint PJIs was performed to support expert statements. Results: All suspected infections were recommended to be managed surgically, with strong support for debridement and prosthesis neck exchange in acute infections. Trapeziectomy was endorsed as a salvage strategy in acute and chronic cases. Six weeks of antibiotic therapy, initiated intravenously and followed by oral administration, was strongly recommended. Amoxicillin/clavulanate and clindamycin were preferred empirical agents. The use of rifampicin was conditionally supported in confirmed Staphylococcus aureus infections. A 12-week interval between intraarticular corticosteroid injection and prosthesis implantation was recommended. Discussion: This Delphi process, supported by literature review, provides the first structured guidance for the management of PJIs of the trapeziometacarpal joint of the thumb. Recommendations align with principles from large-joint infection management but are tailored to the anatomical and clinical context of the hand. These statements establish a practical framework for clinical decision-making and highlight priorities for future research.