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Revision Trapeziometacarpal Arthroplasty with Dermal Xenograft Interposition
Michael Doarn, MD; John Fernandez, MD
Midwest Orthopaedics at Rush, Chicago, IL

Purpose: To evaluate a surgical technique for failed primary trapeziometacarpal arthroplasty (TMA).

Methods: A retrospective review of all patients treated with a porcine dermal matrix (Conexa) for failed TMA by a single surgeon at a single institution was performed. Data collected included primary procedure performed, reason for failure, time from failure to revision surgery, thumb range of motion, grip strength, pinch strength, return to work, VAS pain score, pre-operative and post-operative radiographs, and complications.

Results: Three hundred and fifty five thumb TMA procedures were performed from 2005-2015. Of these, 9 (2%) were revision procedures. Seven of the 9 revisions were performed with xenograft interposition and 2 with flexor carpi radialis interposition. These 7 TMA revisions in 7 patients with a mean age of 57 years were included for final data evaluation. Four were performed on the right hand and three on the left hand. The mean time from primary procedure for TMA arthritis to revision surgery was 120 weeks (14-520). Original procedures included flexor carpi radialis ligament reconstruction tendon interposition (LRTI) (3/7), APL suspensionplasty (3/7), and TMA titanium joint arthroplasty (1/7). All revisions were performed for continued thumb pain, subsidence of the thumb metacarpal, and index metacarpal impingement. The mean follow-up of patients was 41 weeks (5-151). Mean Thumb interphalangeal ROM was 0-58 degrees and mean metacarpalphalangeal ROM was 0-40 degrees. Mean VAS pain score on final follow-up was 1.7 out of 10. Mean grip strength was 18 kg and mean pinch strength was 6 kg in the affected hand. Mean grip strength was 22 kg and mean pinch strength was 6 kg in the unaffected hand. Mean return to work was 23 weeks. Final radiographs of the involved thumb showed change in 1st-2nd metacarpal space from 1.5mm to 3.1mm. Change in thumb metacarpal - scaphoid space from 2.5mm to 5.3mm. No complications were encountered in any patient.

Conclusions: Treatment of a failed primary TMA with porcine xenograft dermal matrix shows good clinical outcomes for patients and is a valid treatment option when facing these difficult revisions.

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