title: Salvage reconstruction of failed interposition arthroplasty at the base of the thumb.
abstract: We present an operative procedure designed to revise a failed arthroplasty at the base of the thumb. This report describes a reliable operation that corrects residual instability and malignment which results in thumbs that are weak and painful despite a previous procedure. The operation has also been used as a primary procedure for arthritis of the trapeziometacarpal joint where instability and subluxation was a major component of the problem requiring joint reconstruction. The unique features of this procedure include a reinforced double-thickness tendon graft, a unique tendon anchor, and a fascia lata allograft spacer. Significant functional improvement is anticipated when joint reconstruction provides increased proximal stability. Pinch and grip measurements improve. Pain scores also diminish after the operation. Hand function and patient satisfaction can be substantially improved with revision arthroplasty when the initial operation has failed to provide a thumb that is mobile, stable, and pain free. The technical features of the procedure address reduction of malignment, restoring of anatomic balance, and secure fixation of the proximal apex of the thumb metacarpal which restores thumb reduction position and digital balance.
authors.affiliation: Department of Orthopaedic Surgery, University of California San Diego, CA, USA. rbraun@handsrus.com
authors.forename: Richard M
authors.initials: RM
authors.lastname: Braun
authors.forename: Mark
authors.initials: M
authors.lastname: Rechnic
authors.forename: Kalpit N
authors.initials: KN
authors.lastname: Shah
mesh_terms: D001178:Arthroplasty / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D011182:Postoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D016879:Salvage Therapy; D013536:Suture Techniques; D013933:Thumb / Q000601:surgery*; D017211:Treatment Failure