Failed Thumb Basal Joint Arthroplasty: An Analysis of Common Etiologies Leading to Reoperation.

PURPOSE

Hand osteoarthritis contributes considerably to functional disability, and the basal joint is the most common site treated surgically. Procedure choice is largely based on surgeon preference, and causes of primary basal joint arthroplasty failure and prevalence of revision are poorly defined. We seek to understand the etiologies of revision basal joint surgery.

METHODS

Retrospective medical record review identified 26 reoperations in 24 thumbs in 23 patients by two senior hand surgeons following primary basal joint arthroplasty performed for osteoarthritis from 2014 to 2022. Chart review yielded demographic and historical information, surgical technique of index and revision procedures, presenting symptoms, time to reoperation, and intraoperative revision findings. Radiographic measures included prerevision thumb metacarpal subsidence, radial subluxation, scaphoid impingement, and untreated scaphotrapezoid arthritis.

RESULTS

All patients complained primarily of pain on presentation, followed by impaired function (n = 11) and dorsal thumb dysesthesias (n = 2). Physical findings included metacarpophalangeal joint hyperextension (n = 12), axial thumb instability (n = 10), and inability to flatten the palm (n = 5); the latter occurred in four of seven thumbs having index TightRope or swivel-lock procedures and one thumb having ligament reconstruction and tendon interposition with a swivel-lock device. Six patients (25.0%) had "other" pathologies including carpal tunnel syndrome, palpable foreign body, capitate subluxation, and absent EPL function. Radiographs revealed untreated scaphotrapezoid arthritis (18), radial metacarpal base subluxation (18), proximal thumb metacarpal migration (17), and trapezial space height < 5 mm (16). Intraoperative revision findings included proximal thumb metacarpal migration (12), untreated scaphotrapezoid arthritis (9), foreign body granuloma (6), metacarpophalangeal joint hyperextension (5), impinging osteophytes (4), scaphoid-metacarpal impingement (3), and suture anchor pull-out (2).

CONCLUSIONS

The most common pathologies encountered during revision basal joint arthroplasty include trapeziometacarpal instability, unrecognized scaphotrapezoid arthritis, and untreated metacarpophalangeal joint hyperextension. Dysfunction resulted from iatrogenic inability to flatten the palm associated with use of swivel-lock and TightRope anchor devices to stabilize the thumb metacarpal.

TYPE OF STUDY/LEVEL OF EVIDENCE: Differential Diagnosis/Symptom Prevalence Study IV.