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Despite the massive financial and human efforts of hospitals in the Flemish part of Belgium to increase quality through the path of external accreditation, so far this has not convinced the end user, in casu the patient. In this study of 307 hospital patients we conclude that the knowledge about accreditation is very limited to none existent (2%) in a sample of Belgian patients not working in medical practice and that patients do not choose their hospital care in accordance to the accreditation status of the hospital. We remain convinced that improving quality is a continuous concern for medical professionals and hospital management. However, we believe that patients, medical professionals and hospital managers might define quality care in a somewhat different way and we question the methodology of imposing a 2 vast amount of strict protocols as a way to improve quality in patient care. There is no conclusive evidence to support that these uniformly imposed “quality programs” improve patient care, except on safety issues.

The purpose is to determine if ligament reconstruction with tendon interposition (LRTI) is a recommendable salvage option for failed total joint prosthesis of the first carpometacarpal joint. Twenty-two patients in our database met the in- clusion criteria for this retrospective study, with at least 6 months follow-up. Fourteen participated and were invited for a clinical examination and asked to fill out two questionnaires. They were evaluated for pain (VAS), impairment (NHS), disability (Quick DASH), opposition (Kapandji test) and grip strength (hydraulic dynamometer). Results of the questionnaires were compared to a cohort study of primary LRTI’s. Kapandji test and grip strength were compared to the contralateral side. Compared to primary LRTI’s, revision surgery showed mild deterioration of impairment and disability. The average VAS score was 2.9 out of 10. Twelve patients mentioned a sense of strength loss, which could be quantified with the dynamometer : a mean of 15.1 kg (operated thumb) versus 20.5 kg (contralateral). There was a relatively small decline of opposition with Kapandji 8.6 versus 9.9. The overall satisfaction was good for 8 patients, fair for 3 and poor for the remaining 3 (mainly based on strength loss). One patient needed a second revision. Failed first carpometacarpal joint replacement can be salvaged by ligament reconstruction with tendon interposition, providing an acceptable functional outcome in 79% of cases studied. However, compared to the functional outcome of primary LRTI’s, mild aggravation of impairment and disability should be taken into account.