Revision of trapeziometacarpal arthroplasty: risk factors, procedures and outcomes

Abstract

Background and purpose — Revision surgery after trapeziometacarpal arthroplasty is sometimes required. Varying revision rates and outcomes have been reported in rather small patient series. Data on risk factors for revision surgery, on the final outcome of revision, and possible factors affecting the outcome of revision are also limited. We evaluated these factors in 50 patients. Patients and methods — From 1,142 trapeziometacarpal arthroplasties performed during a 10-year period, 50 patients with 65 revision surgeries were retrospectively identified and invited to participate in a follow-up study involving subjective, objective, and radiologic evaluation. The revision rate, risk factors for revision, and factors affecting the outcome of revision were analyzed. Results — The revision rate was 5%. Scaphometacarpal impingement was the most common reason for revision surgery. Patient age ≤ 55 years was a risk factor with a revision rate of 9% in this age group, whereas an operation on both thumbs during the follow-up period was a negative risk factor for revision surgery. There was no difference in revision risk between ligament reconstruction and tendon interposition with or without a bone tunnel. 9 patients had multiple revision procedures and their final outcome did not differ significantly from patients revised only once. Most of the patients felt subjectively that they had benefited from revision surgery and the subjective outcome measures (QuickDash and pain VAS) and the Conolly score were in the same range as previously described for revision trapeziometacarpal arthroplasty. Interpretation — Age ≤ 55 years is a risk factor for revision surgery. The type of primary surgery does not affect the risk of revision surgery and multiple revision procedures do not result in worse outcomes than cases revised only once. Mechanical pain caused by contact between the metacarpal and scaphoid is the most common indication for revision surgery. In general, patients seem to benefit from revision surgery for trapeziometacarpal osteoarthritis.

Outcomes and recommendations for revision of thumb carpometacarpal resection arthroplasty

“…This is in contrast to the findings of a small matched-pair study showing neither any differences in pain nor hand function between patients after trapeziectomy for failed implant arthroplasty or primary trapeziectomy (Kaszap et al, 2013). Nevertheless, our scores are in line with or slightly better than those reported by other groups reporting on pain (lying between 2.8 and 4.2 on the numeric rating scale) after revision surgery (Mattila and Waris, 2019;Megerle et al, 2011;Munns et al, 2019).…”

“…Trapezium resection alone or with ligament reconstruction and tendon interposition (LRTI) offers considerable pain relief and functional restoration in patients with thumb carpometacarpal (CMC) osteoarthritis (OA) (Vermeulen et al., 2011; Wajon et al., 2015; Yeoman et al., 2019). Despite the mainly good outcomes, 2.5% to 5% of patients require revision surgery due to persistent pain, instability, subsidence of the first metacarpal (MC) bone, weakness and/or untreated peritrapezial or other midcarpal OA (Cooney et al., 2006; Hess et al., 2018; Mattila and Waris, 2019; Munns et al., 2019). Younger patients tend to have a higher risk for revision surgery than older patients (Mattila and Waris, 2019).…”

Risk of Infection in Thumb Carpometacarpal Surgery After Corticosteroid Injection

“…Finally, an evaluation of repeat surgery for the treatment of the first metacarpal instability and/or hardware failure is not included in our study design; the management of such complications has been previously reported. 22 Patients who receive an intra-articular corticosteroid injection within 3 months before surgery for CMC joint arthritis of the thumb may be at increased risk in the first 90 days postoperatively for additional surgery to treat a wound complication/infection. Although further studies are needed to draw definitive conclusions, intra-articular injections may be a modifiable risk factor for infection in the 3 months before surgery to treat thumb CMC joint arthritis.…”

Trapeziectomy with Ligament Reconstruction and Tendon Interposition versus Trapeziometacarpal Joint Replacement for Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis

“…28 In comparison, the revision rate for trapeziectomy (including those with and without LRTI) is said to be 4.6% at 10 years. 29 It may be hard to justify the small functional and symptom improvement conferred by joint replacement when revision rates are much higher than that of trapeziectomy. Moreover, trapeziectomy with LRTI has been shown to confer a greater degree of thumb opposition than joint replacement, with equivalent VAS pain scores, pinch strength, and grip strength.…”