Revision Thumb Carpometacarpal Arthroplasty

Diagnostic and treatment recommendations for recurrent or persistent symptoms after trapeziectomy: a Delphi study

The aim of this Delphi study was to provide a diagnostic and treatment algorithm for patients with persistent or recurrent symptoms after trapeziometacarpal joint resection arthroplasty. Three Delphi rounds were conducted in which surveys were sent to 182 experienced hand surgeons worldwide. Responses were received from 140 participants. A consensus threshold was set at 67% agreement. Diagnostic tools and treatment approaches for six common revision scenarios achieved consensus. Radiographs are appropriate as primary (97%) and CT scans as secondary (76%) diagnostic tools. For scaphometacarpal impingement, 67% of respondents agreed that revision interposition is appropriate, with 93% recommending autologous tendon for the interposition. Additional suspension was considered appropriate by 68% of the participants. The diagnostic and treatment algorithm can help the surgeon to identify the reason for persistent symptoms after trapeziometacarpal joint resection arthroplasty and to choose an appropriate treatment strategy.Level of evidence: V.

Management of a Traumatic Collapse of the First Carpometacarpal Joint After Trapeziectomy With Suture Suspensionplasty: A Case Report

Arthritis of the first carpometacarpal (CMC) joint is a common pathology hand surgeons encounter. Treatment begins with conservative measures, but when they fail, surgery is a viable option for providing relief to patients. The most widely used surgical technique is CMC arthroplasty with ligament reconstruction and tendon interposition (LRTI). However, more novel techniques such as trapeziectomy with suspensionplasty are gaining popularity. When surgical measures fail, it is important to identify the mechanism of failure and proper treatment options. There are multiple options for revision surgery at the surgeon's disposal, with no consensus on a superior technique. This case illustrates a patient with painful subsidence secondary to a traumatic collapse of the first CMC joint eight months status post suspensionplasty with trapeziectomy. After conservative measures failed to provide relief, it was decided that a surgical revision was appropriate. The surgeon chose to move forward with suture button suspensionplasty, as it has multiple advantages over LRTI. In the short-term follow-up after revision, the patient experienced improvements in pain and range of motion, along with radiographic evidence of proper alignment of the first metacarpal without subsidence. Regarding the treatment of a case such as this, the authors believe this case should serve as a reference that may be used by future physicians when deciding which surgical technique to employ for the revision of a traumatically collapsed first CMC joint after trapeziectomy with CMC joint suspensionplasty.

Basal thumb arthritis surgery: complications and its management

The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.