gms | German Medical Science

Objectives/Interrogation: Osteoarthritis of the trapeziometacarpal joint is a common problem that affects up to 10% of women between the ages of 45 and 70. The majority of patients are treated by trapeziectomy, which can be associated with interposition- and suspension arthroplasty. Different ligament reconstruction techniques have been described over the years. However, there is a small group of patients who only have a temporary benefit from the first surgical treatment, or not have any at all. The persistence of symptoms such as pain or impaired range of motion after surgery is considered a failure of the treatment.

In our clinic, several revision surgeries using the Carpo Metacarpal Implant® (CMI®) were performed. The rationale behind this treatment, is that a neoarticulation through proximalization of the base of the first metacarpal base with scaphoid or trapezoid can be treated by resection of the articular surface of the first metacarpal base and replacing it with a non-cemented monopolar implant. This treatment has not been described in the literature before.

The goal of this study was to follow up patients who have had a trapeziectomy with tendon arthroplasty and who needed revision surgery because of neoarticulation through proximalization.

Methods: We examined patients who received a CMI® Prosthesis after failed trapeziectomy with tendon arthroplasty with a retrospective follow-up examination concerning pain, range of motion, grip and pinch strength and radiographic evaluation.

Results and Conclusions: We describe three female patients, with a mean follow up of 7 years. Mean age at treatment was 58 years, at revision 61 years. Primary surgery was performed by trapeziectomy with one FCR and two APL arthroplasties. At follow up, overall range of motion was 86.8% of the opposite extremity. Mean grip strength was 83.3% and pinch strength 59.7% of the contralateral side. Mean Quick DASH score was 12.1, mean VAS with maximal weight bearing was 3.7/10. Radiologically, no progressive proximalization was seen. One patient also had an MCP arthrodesis at the time of revision surgery. One patient showed no Z-deformity and the third patient developed a mild Z-deformity with MCP extension of 35 degrees. Subjectively, all patients were happy with the outcome despite of their residual complaints.

Concluding, in our opinion, the non-cemented monopolar CMI® Prosthesis is a good option for treatment of persisting pain after trapeziectomy because of neoarticulation through proximalization.