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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Risk factors and outcomes of revision trapeziometacarpal arthroplasty

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  • presenting/speaker Simo Mattila - Helsinki University Hospital, Department of Hand Surgery, Helsinki, Finland
  • Eero Waris - Helsinki University Hospital, Department of Hand Surgery, Helsinki, Finland

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-538

doi: 10.3205/19ifssh1136, urn:nbn:de:0183-19ifssh11368

Published: February 6, 2020

© 2020 Mattila et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Although the majority of trapeziometacarpal arthroplasties result in favorable outcomes, 3-5% of patients do not benefit from the procedure at all or develop recurrent symptoms making revision surgery nescessary. Outcomes of revision surgery have been reported in rather small patient series. Studies comparing outcomes of revision surgery after conventional resection arthroplasty and implant arthroplasty are lacking and data on risk factors for revision surgery is limited.

Methods: A chart review of the years 2003-2013 identified 1174 trapeziometacarpal arthroplasties. Of these 32 were performed with an implant. Altogether, 69 patients had had a total of 88 revision procedures. At a clinical and radiologic followup visit subjective analysis was carried out with the Quick disabilities of the arm, shoulder and hand score, patient evaluation measure and visual analog score for pain. Objective assessment included strength and range of motion measurements. Standard posteroanterior radiographs of the hand were obtained. The revision rate, risk factors for revision, factors affecting the outcome of revision and the outcomes of revised patients were analyzed.

Results and Conclusions: The revision rate was 4.6 % for conventional arthroplasty and 59.4 % for implant arthroplasty. Patient age under 55 years was a risk factor (OR 3.3, p=0.00) and an operation on both thumbs at some point in time was a negative risk factor for revision surgery (OR 0.444, p=0.021). There was no difference in revision risk between tendon interposition ligament reconstruction with or without a bone tunnel (p=0.267). No factors affecting the outcome of revision surgery could be identified and there was no difference in outcomes after revision between cases operated on primarily with conventional or implant techniques.

The revision rate is in the same range as previously described. Young age is a risk factor for revision and ligament reconstruction tendon interposition with a bone tunnel does not reduce the risk of revision surgery. Multiple revision procedures do not result in worse outcomes than cases revised only once. The final outcome after revision seems to be the same regardless of the primary surgical method used for trapeziometacarpal arthroplasty.