## 4 Discussion
[PERSON] compares prosthesis and trapeziectomy with tendon interposition, finding that the prosthesis offers faster recovery and better pain relief in the first 3 months but carries a risk of loosening [26]. The results of [PERSON] et al. suggest, in the short term, that arthroplasty using the MAATMR prosthesis provides outcomes comparable to trapeziectomy with suspensionplasty [27]. However, the difference in our sample was not statistically significant, highlighting that both methods are viable for maintaining or improving joint function. The published evidence did not show that total arthroplasty was superior to trapeziectomy and its variants. On the other hand, using implants has a higher complication rate and a significant extra cost [28]. The primary complications associated with these techniques include postoperative pain, [PERSON]'s syndrome, radial nerve injuries, and, in the case of arthroplasty, prosthetic component mobilization. Literature reports indicate that prosthetic arthroplasty carries an 8% risk of implant loosening or mobilization over time, while suspension tenoplasty is often associated with persistent postoperative pain, occurring in approximately 15% of cases [5; 24]. Despite these known risks, it is noteworthy that throughout the follow-up period in our study, none of the patients in each treatment group experienced these specific complications. Our findings suggest that both surgical approaches, when performed following a standardized protocol and postoperative care, may offer favorable outcomes with a low incidence of adverse events. Instead, revision surgery for trapeziometacarpal prostheses is typically just a standard trapeziectomy, with the same follow-up as a first-line trapeziectomy. By contrast, revision surgery for trapeziectomies is much more complex and yields uncertain results [29]. In a systematic review, [PERSON] et al. found a high rate (12.3%) of postoperative complications in arthroplasty implants [4]. [PERSON] et al. found that suture suspensionplasty after trapeziectomy for thumb arthritis maintained 42% of the trapezial space at 2.1 years, achieving pain relief and functional outcomes comparable to other techniques [30]. In our sample, we did not observe a similarly significant number of complications. The absence of significant complications in either group further underscores the safety of both procedures. Group B had a slightly higher patient satisfaction and less pain at 3 months, possibly due to the perceived advantages of the dual-mobility prosthesis, such as better thumb length preservation and grip strength [31]. However, these benefits did not translate into statistically superior outcomes, which aligns with previous literature suggesting no clear superiority among various surgical techniques for TMJ OA. It is important to note that the Eaton-Littler stage considered in our study was Stage III, where both techniques are particularly applicable. Additionally, transposition techniques are typically reserved for more advanced stages of the disease, further highlighting the need to tailor the surgical approach to the specific clinical scenario. Arthroplasty is associated with higher costs, which may influence decision-making in certain healthcare settings. There are several limitations to consider in this study. The relatively small sample size and the midterm follow-up period limit the generalizability of the results. Long-term studies with larger cohorts are necessary to confirm these findings and assess the durability of the outcomes. Statistical differences across sex and age were not analyzed, despite these factors potentially influencing outcomes. Additionally, the single-surgeon setting, while ensuring consistency in surgical technique, may introduce bias and limit the applicability of the results to broader clinical practice. Failure to consider potential confounders, such as variations in rehabilitation adherence, hand dominance, or baseline differences in joint degeneration between groups, represented another limitation of the study.