Failed Trapeziectomy Treated by Thumb Metacarpal Base Arthrodesis: A Case Series

A systematic review of management options for symptomatic scaphometacarpal impingement after trapeziectomy

Pain after trapeziectomy is a vexing problem, most commonly due to scaphometacarpal impingement. A number of treatment strategies have been described and are examined in this systematic review. In total, 27 studies describing revision surgery for unsatisfactory results after trapeziectomy were included. Results after soft tissue or synthetic suspensionplasties, arthrodesis procedures, implant arthroplasty and costochondral autografting were included. Most studies were heterogeneous in terms of patient selection and procedure performed, and the level of evidence and methodological quality were uniformly low. Autologous suspensionplasty procedures are the best studied and most rigorously reported techniques, with modest improvements in pain widely reported. Newer techniques using synthetic suture button suspension are encouraging with the benefit of earlier mobilization but require further study. Due to high incidences of complication and revision, the literature does not support the use of implant arthroplasty after trapeziectomy. Arthrodesis appears to be a reasonable last resort when attempts at suspension have failed.

Arthrodesis of the First to Second Metacarpal for Definitive Management of Failed Thumb Carpometacarpal Arthroplasty: A Case Series

Thumb carpometacarpal (CMC) arthroplasty with resection of the trapezium and soft tissue interposition, with or without ligament reconstruction, has historically proven to be an efficacious treatment for thumb CMC arthritis. The incidence of failure following primary thumb CMC arthroplasty is low; however, the evaluation and management of a patient experiencing an unsatisfactory outcome following CMC arthroplasty is challenging. If symptoms are refractory to conservative measures, then revision surgical treatment may be indicated. Clinical decision making becomes even more complicated in cases of failure after an initial revision surgery has already been performed. In patients with a failed CMC arthroplasty revision in whom all soft tissue options have been exhausted, the senior author considers arthrodesis of the first metacarpal base to the second metacarpal base as a salvage procedure. The authors describe this surgical technique and present our experience with 4 cases in 3 patients who underwent this surgical intervention. Successful radiographic fusion was achieved in all 4 cases, with satisfactory clinical outcome in 3 out of 4 cases, supporting this surgical technique as a definitive option for patients who have failed multiple CMC arthroplasty revision surgeries.

Arthroscopy-assisted partial trapeziectomy combined with ligament reconstruction for thumb carpometacarpal joint osteoarthritis: A different technique

BACKGROUND

There is no consensus on the best surgery option for thumb carpometacarpal osteoarthritis (CMC OA). The traditional method has the risk of large trauma, obvious metacarpal subsidence, and decreased stability. The aim of this study is to introduce a different technique to restore the function and stability of the first carpal metacarpal joint with minimal trauma, rapid pain relief, reduced complications, and the clinical outcomes in the long-term follow-up was evaluated and statistically analyzed.

METHODS

This was a retrospective study of 10 patients with a mean age of 51.8 years. The surgery consisted of removing partial trapezium through arthroscopy, reconstructing the stability with flexor carpi radialis suspension and tendon interposition. The subjective assessment included visual analog scale (VAS) of pain, quick disabilities of the arm, shoulder, and hand (Quick-DASH) score, and patient satisfaction. The range of motion, grip strength, pinch strength, and radiographic assessment, which can reflect stability of the thumb, were objectively evaluated and statistically analyzed.

RESULTS

Ten patients were monitored at a mean follow-up of 6.8 years. The mean grip strength improved significantly from 16.64 to 22.57 kg after surgery. Pinch strength improved significantly from 3.72 to 5.71 kg on average. The Kapandji score improved significantly from 5.7 to 8.6 on average. 80% (8/10) of the patients were satisfied with this surgery. On objective indicators, the VAS score decreased significantly from 6.4 to 1.3 on average. The mean Quick-DASH score improved significantly from 6.1 to 28.9. Postoperative x-ray showed slight subsidence and dislocation of the first metacarpal in two patients and did not affect the function by measurement.

CONCLUSION

Arthroscopy-assisted partial trapezium resection combined with ligament reconstruction could be a workable and promising surgical technique in patients with thumb CMC OA. It can offer the advantages of minimizing surgical injury by preserving the first carpal metacarpal joint capsule to protect its stability, with a rapid pain relief, function improvement, and satisfactory results in patients' clinical measurements.