ABSTRACT
Total trapeziometacarpal (TMC) joint replacement is increasingly being performed for the treatment of basal joint arthritis. However, complications such as instability or loosening are also frequent with TMC ball-and-socket joint replacement. Management of these complications lacks consensus. The purpose of this study was to report the results of 12 cases of failed TMC joint replacement that were treated by trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty. The follow-up consisted of functional (numerical scale, DASH score, satisfaction), physical (range of motion, strength) and radiological (Barron and Eaton ratio measurement) assessments. At a mean follow-up of 21 months, 11 patients were satisfied or very satisfied after surgery. The mean pain score was 2/10 and the mean DASH score 30/100. Mean thumb palmar and radial abduction was 40°. Thumb opposition measured by the Kapandji technique was 9/10. The height ratio was slightly increased. Trapeziectomy with LRTI after TMC joint replacement appears to be an attractive salvage procedure.
Subject(s)
Arthroplasty, Replacement , Ligaments, Articular/surgery , Metacarpal Bones/surgery , Postoperative Complications/surgery , Reoperation/methods , Tendons/surgery , Trapezium Bone/surgery , Adult , Aged , Female , Humans , Middle Aged , Osteoarthritis/surgery , Patient Satisfaction , Plastic Surgery Procedures/methods , Treatment OutcomeABSTRACT
The authors are reporting on a patient with chronic posttraumatic instability of the thumb metacarpophalangeal joint in extension. Conservative treatment had failed. Upon surgical exploration, it was found that no capsular or ligamentous structures were available for adequate repair. A volar carpi radialis ligamentoplasty stabilized with bone anchors was performed. Stability and good functional result were obtained.
