Revision Ligament Reconstruction Tendon Interposition for Trapeziometacarpal Arthritis: A Case-Control Investigation

Abstract

Purpose To test the null hypothesis that there is no difference in patient-reported and objective outcomes of revision ligament reconstruction and tendon interposition (LRTI) compared to primary LRTI. Methods This case-control investigation enrolled 10 patients who had undergone revision LRTI at a tertiary care center. All patients had previously undergone primary trapeziectomy with LRTI. Patients with a minimum of two years of follow-up were eligible. All patients completed an in-office study evaluation. Controls (treated only with primary LRTI) were matched from our practice to reach a 1:2 case to control ratio. Outcome measures included Michigan Hand Questionnaire (primary outcome), Quick Disability of the Arm, Hand, and Shoulder (QuickDASH) Questionnaire, VAS for pain and improvement, and physical examination. Statistical analyses were conducted to compare the patient groups. Results Revision LRTI patients reported significantly worse outcomes on all measured standardized questionnaires compared with primary patients. The Michigan Hand Questionnaire indicated worse overall outcomes (54 versus 79) as well as worse pain, appearance, and ability to complete activities of daily living. Revision LRTI patients also reported more impairment (QuickDASH 47 versus 23), greater pain (VAS pain 6.3 versus 1), and less improvement after surgery (VAS improvement 2.7 versus 7.9). There was also a significantly higher rate of patient-reported depression in the revision LRTI group (50% versus 10% of primary LRTI patients). We did not find a significant difference in objective outcomes of pinch strength, grip strength, and thumb palmar abduction between the two groups. Conclusion Following revision LRTI patient-reported outcomes indicate worse perceived function and greater pain than expected following primary LRTI despite similar motion and strength. Revision surgery can be offered in the setting of persistent or recurrent symptoms, but patients should be counseled that improvement of symptoms is unpredictable.

Revision of trapeziometacarpal arthroplasty: risk factors, procedures and outcomes

“…Our results and the literature show that the majority of patients seem to benefit from revision surgery but the final outcome may still be worse than that of non-revised patients (Sadhu et al. 2016). The results of cases revised multiple times were not worse than those revised only once.…”

“…2011, Sadhu et al. 2016). Our results and the literature show that the majority of patients seem to benefit from revision surgery but the final outcome may still be worse than that of non-revised patients (Sadhu et al.…”

Early Cup Loosening After Metal-on-Metal Total Joint Replacement of the Trapeziometacarpal Joint: A Retrieval Study

“…This is in concordance with two other papers, where the rate of reoperation has been stipulated to be 2-3 % (Cooney et al, 2006;Megerle et al, 2011), but the article does not discuss in detail the difficulties involved in addressing failed trapeziectomies surgically. This surgery is highly challenging and the results are unpredictable with success rates quoted from 20-84 % (Cooney et al, 2006;Megerle et al, 2011;Papatheodorou et al, 2017;Sadhu et al, 2016).…”

Current trends in the management of trapeziometacarpal arthritis

“…They reported worsened outcomes for revision patients, including more functional impairment, greater pain, and less improvement after surgery, and recommended that patients considering revision LRTI be advised that improvement of symptoms can be unpredictable compared to primary LRTI. 25 …”