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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Outcomes of Arthrodesis for Management of Failed Basal Thumb Arthroplasty
Maureen A O'Shaughnessy, MD; Mayo Clinic, Rochester, MN; Marco Rizzo, MD; Orthopedics, Mayo Clinic, Rochester, MN

Introduction:

Basilar thumb arthritis is often treated with carpometacarpal arthroplasty. When arthroplasty fails, often due to pain or subsidence, salvage operations may be indicated. Fusion of the basilar thumb joint is an option but may have increased complications. Current literature does not adequately outline the indications for and results of thumb arthrodesis in the setting of failed basilar thumb arthroplasty.

Materials and Methods: IRB-approved retrospective review was performed of all patients undergoing fusion following failed basilar thumb arthroplasty between 1990-2016. At latest follow up, data including grip strength, radiographic appearance, complications and need for revision surgery were recorded.

Results:

The series includes 7 thumbs in 6 patients (3 female, 3 male) with average age at surgery of 53 (range 45-61). Average follow-up was 27.5 months (range 9-66). Patients had on average 2 prior surgeries (range 1-7) and an average of 42 months duration from initial basilar thumb surgery (range 24-60). Prior basilar thumb surgeries consisted of trapeziectomy and suspensionplasty (6), pyrocarbon implant arthroplasty (2) (figure 1), and failed fusion attempt after suspensionplasty (1). All cases elected to undergo thumb fusion surgery due to persistent pain, with one patient also complaining of subsidence and deformity.

Surgical intervention included fusion between thumb and index metacarpals and trapezoid (6) and fusion between thumb metacarpal and trapezoid in the setting of failed implant arthroplasty (1).

Average imaging follow up (radiograph or computerized tomography scan) was 22 months (range 4-61) which showed fusion in 5/7 thumbs. Patients had average grip strength of 64% (expressed as percent of contralateral), appositional grip 72%, and oppositional grip 79% at final follow-up.

Complications included minor pin site infection treated with oral antibiotics (2) and symptomatic screw hardware requiring removal (2). Five patients experienced delayed union, 4 were asymptomatic and observed. 1 symptomatic patient underwent successful revision fusion with cannulated screw fixation (figure 2).

Conclusions:

Fusion after failed thumb arthroplasty is a reliable pain relieving procedure however complication rates are high (58%). Risk of delayed or nonunion is high with 5/7 patients (71%) experiencing delayed (4) or nonunion (1). This study is significant as it enable surgeons to provide reasonable expectations regarding outcomes of fusion for failed arthroplasty of the first carpometacarpal joint.

figure 1.jpgfigure 2.jpg


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