Revision Strategies for Complications and Failure of Trapeziometacarpal Joint Arthroplasty Based on Residual Trapezial Bone Stock.

Abstract

The main reasons for revision surgery after primary trapeziometacarpal (TM) joint prosthetic implantation are trapezium loosening and instability. Although secondary trapeziectomy is the gold standard, here we describe alternative surgical procedures that can be integrated in a revision strategy based on residual trapezial bone stock after implant removal. This single-center retrospective study analyzed the clinical and radiologic results for 41 patients who underwent surgical TM joint prothesis revision from 2006 to 2021 at our institution. We applied a classification of trapezium bone loss after removal of the failed prosthetic cup for deciding on the surgical revision strategy. The minimum follow-up was 24 months. If no bone loss was observed, trapezium cup replacement was performed. With trapezium loosening and limited central bone loss, cancellous bone grafting was performed before cup implantation in patients <85 years old, whereas a cemented cup was implanted in patients >85 years. With an excavated trapezium, a corticocancellous bone graft was impacted into the residual trapezium before cup implantation. With trapezium destruction, trapeziectomy was considered the gold standard. Pyrocarbon and scaphometacarpal implants were part of the strategy. Follow-up after surgical revision was a mean of 73 months (range 35-202). The mean visual analog scale score for pain was 2.1 ± 1.7, mean Disabilities of the Arm, Shoulder, and Hand score was 24/100 ± 18, and mean Kapandji opposition scale was 8.6/10 ± 11. Mean pinch strength was 63% and mean grip strength 61% of the contralateral side. We report five cases (12%) of additional surgical procedures for failed primary surgical revision. Although uncommon, complications of TM joint prosthesis are mainly trapezium failure. The choice of alternative surgical options to secondary trapeziectomy can be based on residual trapezium bone stock. Overall, these surgical options had good clinical results, but the rate of secondary revision was high. Therapeutic IV.