Salvage revision arthroplasty after failed TMC joint prosthesis

Abstract

The purpose of this retrospective study was to describe our experience with failed TMC joint prostheses and to report the results of 7 cases that were treated by a salvage revision arthroplasty. We only performed this salvage arthroplasty when partial (cup replacement) or total replacement of TMC prosthesis was not possible. We performed a resection arthroplasty with (partial) trapezial excision and spacer insertion to prevent scaphometacarpal collaps. We used the proximal part of the Ascencion® MCP implant (Integra) as spacer. Among our 7 patients, 3 were satisfied with a VAS satisfaction of 8 or more. Four patients had pain levels less than or equal to 3. Our mean DASH score was 32.7. Our patients had good opposition and retropulsion scores and the mean TMC joint flexion and abduction values were both 40°. But tip and key pinch ipsilateral was insufficient (mean tip pinch of 2kg and key pinch of 1kg).

We believe that the salvage revision arthroplasty with (partial) trapezial excision and spacer insertion is a valuable treatment option for failed TMC joint replacement. But further research needs to compare all the  different revision options after TMC joint replacement in a multicenter randomized controlled trial.