Trapeziectomy and ligament reconstruction tendon interposition after failed trapeziometacarpal joint replacement.
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.
Service de chirurgie de la main et du membre supérieur, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: hubert.lenoir@laposte.net.
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Lenoir
Unité d'orthopédie-traumatologie : membre supérieur, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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Erbland
Centre de chirurgie de la main, clinique du Parc Léopold, rue Froissart, 38, 1040 Bruxelles, Belgium.
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Lumens
Service de chirurgie de la main et du membre supérieur, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Coulet
Service de chirurgie de la main et du membre supérieur, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Chammas
D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D050279:Metacarpal Bones / Q000601:surgery*; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation / Q000379:methods*; D013710:Tendons / Q000601:surgery*; D051222:Trapezium Bone / Q000601:surgery*; D016896:Treatment Outcome
LRTI; Ligamentoplastie; Ligamentoplasty; Prothèse trapézo-métacarpienne; Revision; Révision; TITL; Trapeziectomy; Trapeziometacarpal arthroplasty; Trapézectomie