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Outcomes of a Cementless Thumb Basal Joint Hemiarthroplasty for Treatment of Trapeziometacarpal Osteoarthritis
Patrick G. Marinello, MD; Mark Shreve, MD; Peter J. Evans, MD, PhD
Cleveland Clinic Foundation, Cleveland, OH

Introduction: Multiple surgical procedures and implants have been developed to treat trapeziometacarpal joint osteoarthritis. Recently, a promising thumb basal joint hemiarthroplasty (BioProŽ Modular Thumb; BioPro, Port Huron, MI, USA) was reported in the literature to provide pain relief and improved function. In the aforementioned study, the authors reported a 94% implant survivorship with revision as an endpoint at a mean follow-up of 72.1 months. The purpose of our study was to evaluate the senior author's clinical results and survivorship of thumb basal joint hemiarthroplasty using the same device.

Methods: We performed 35 basal joint hemiarthroplasties in 32 patients from 2011 to 2014. Of these, 26 thumbs (25 patients) had clinical follow-up of at least 12 months. Mean age of the patients was 54 years (range 43-68 years) with 88% females. All patients had Eaton-Littler Stage II or III arthritis pre-operatively. Average follow up was 17.2 months (range 12-26 months). The main outcomes were revision rate and time to revision. Pre- and postoperative radiographs were examined to determine the amount of overall thumb ray lengthening and amount of subsidence of the implant between those revised and unrevised. Student's t-test and Fisher exact test was used for statistical analysis (p<0.05).

Results: At final follow-up 13 of 26 thumbs (50%) had been revised with implant removal, resection of remaining trapezium, and ligament reconstruction with tendon interposition (LRTI). Another 3 thumbs were symptomatic and planning on future revision. Continued pain and implant subsidence through trapezium was the clinical reason for revision. Mean time to revision was 13.8 months (range 8-23 months). Those needing revision were younger (52 vs 57 years p< 0.03) and had index procedure more often on the dominant side (46% vs 31%). There was no significant difference between those revised and unrevised in terms of percentage of thumb ray lengthening (8% vs. 9%, p=0.486) and amount of trapezial subsidence (2.8mm vs. 2.2mm, p=0.202). Kaplan-Meier analysis with revision as the endpoint showed 61% survivorship at mean follow-up of 17.2 months.

Conclusions: Although a limited number of cases were examined, we found poor implant survivorship and an unacceptably high rate of reoperation with the BioPro thumb basal joint hemiarthroplasty device. These results are in stark contrast to previous reports in the literature. Therefore,we can not advocate for continued use of the device and no longer use this implant for thumb basal joint arthroplasty.

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