[Revision of the ARPE prosthesis by the Jones procedure: a study of 6 cases and review of literature].
BACKGROUND
The rate of failure of trapeziometacarpal prostheses increases with time for all types of prosthesis. Procedures for salvage are rarely detailed in the literature.


METHODS
In a series of 43 prosthesis ARPE between 1994 and 2001, 7 revisions (16%) were necessary. Six were treated by trapeziectomy and interposition of the palmaris longus tendon according to the technique of F.E. Jones. The average follow-up was 51 months (9-120). The study contained 5 women and 1 man, all reviewed by the author and the outcome assessed using an original questionnaire. The average age at the time of the revision was 62 years. The revision was necessary on average after 34 months (1 month to 10 years). All the procedures (implantations and revisions) were performed by the same surgeon.


RESULTS
The reason for the revision was loosening of the cup in 4 cases, excessive polyethylene wear in one case and premature dismantling for the last case. Ablation of the cup was straightforward but the extraction of the metacarpal side could still be difficult. For the revision, the Jones procedure did not present difficulties. Thumb function was satisfactory but force was slightly lower than on the opposite side. The scaphometacarpal height was always reduced (34,5% on average). Aesthetically, 2 patients were disappointed and preferred their thumb with prosthesis in place.


CONCLUSIONS
Reports in the literature quote a revision rate of 15% after a follow-up of 4 years. Hence revisions will be more and more frequent in the future. Trapeziectomy with tendinous interposition is an excellent technique of revision because it is reliable medium-term and gives patient satisfaction in terms of thumb function. The results of this technique of revision should be compared with the same technique used as the primary procedure.
Apard
T
T
Département de chirurgie osseuse (Pr Massin), CHU de Angers, 1, rue Larrey, 49033 Angers cedex, Angers, France. thomasapard@yahoo.fr
Saint-Cast
Y
Y
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000601:surgery*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011996:Records; D012086:Reoperation; D012189:Retrospective Studies; D051223:Trapezoid Bone / Q000601:surgery*