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Revision of the Failed Thumb Carpometacarpal Arthroplasty: A Review of 32. Patients
Loukia K. Papatheodorou, MD1; Gary Lourie, MD2; Deidre Bielicka, MD1; Benjamin Rogozinski, MD3; Issei Komatsu, MD1; Dean G. Sotereanos, MD1
1UPMC, University of Pittsburgh, Pittsburgh, PA; 2The Hand and Upper Extremity Center of Georgia, Atlanta, GA; 3Atlanta Medical Center, Atlanta, GA

Introduction: Revising the failed thumb carpometacarpal (CMC) arthroplasty can be daunting. Although several surgical approaches have been described, none have adequately highlighted the ideal procedure for revising the painful failed thumb CMC arthroplasty. We retrospectively analyzed the outcomes of 32 patients from two experienced surgeons at different institutions who underwent revision surgery for this challenging problem.
Materials & Methods: Thirty-two patients who had failed thumb CMC arthroplasty were included in this study. There were 24 women and 8 men with a mean age of 57.7 years at the time of the revision surgery. The primary reason for revision was pain due to instability or metacarpal subsidence. The revision surgery included soft-tissue interposition with or without ligament reconstruction and distraction pinning. Eight patients required concomitant metacarpal phalangeal joint fusion. Eleven patients required concomitant partial excision of trapezoid for scaphotrapezoid arthritis. All patients were evaluated clinically and radiographically. Functional outcome was assessed with a pain VAS scale, measurement of grip strength, key pinch strength and range of motion.
Results: The mean follow-up was 57 months (range, 24 to 121 months). All clinical parameters demonstrated improvement at final follow-up. Twenty-seven patients (84.4%) achieved good functional results and five patients (15.6%) fair. Pain levels by VAS scale were significantly reduced in all patients after revision surgery from mean preoperative 7.2 to postoperative 0.7. Grip strength significantly increased on average from 17 kg preoperatively to 21.4 kg postoperatively. Mean key pinch strength significantly improved from 3.2 kg preoperatively to 4.6 kg postoperatively. The mean radial abduction significantly improved from 61o before revision surgery to 67o and mean palmar abduction of the thumb significantly improved from 57o to 61o. There was not a significant difference in the functional outcome in regards to the method of revision surgery (soft-tissue interposition alone versus with ligament reconstruction) all in combination with distraction pinning. All patients were satisfied with the revision surgery.
Conclusions: Surgery for failed thumb CMC arthroplasty is successful and provides satisfactory functional results with careful attention to clinical and radiographic details. Revision surgery with soft-tissue interposition with or without ligament reconstruction and distraction pinning for failed CMC arthroplasty of the thumb provides pain relief and improves grip and key pinch strength and range of motion of the thumb.

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