Purpose
Pyrocarbon implant hemiarthroplasty is a treatment option for select patients with
trapeziometacarpal joint arthritis. The long-term revision rates after implant arthroplasty
can be as high as 30%. Revision to trapeziectomy has been described for patients who
require implant removal; however, few studies have assessed outcomes in patients in
this subgroup.
Methods
This was a retrospective review of patients who underwent the conversion of a pyrocarbon
carpometacarpal implant to trapeziectomy and suspensionplasty from 2003 to 2019. Patients
who met the criteria were then compared with a matched cohort who underwent primary
trapeziectomy and suspensionplasty. Patients were matched based on the revision procedure,
age, and duration of follow-up. Data regarding demographic information, range of motion,
grip and pinch strengths, and the need for subsequent procedures were collected.
Results
Twenty-five patients underwent the removal of their pyrocarbon carpometacarpal implant.
The patients underwent revision to Thompson suspensionplasty (n = 14), the Weilby
procedure (n = 5), ligament reconstruction tendon interposition (n = 2), or a suture-based
suspension procedure (n = 4). The age, sex, and preoperative range of motion and strength
measures were similar between the 2 groups. All the patients complained of moderate-to-severe
pain prior to surgery, which improved in both groups after surgery. Patients who underwent
the removal of a pyrocarbon arthroplasty implant lost 6.4° of palmar abduction after
surgery. The postoperative grip, opposition strength, apposition pinch strength, and
radial and palmar abduction were similar between the 2 groups.
Conclusions
The removal of a pyrocarbon carpometacarpal implant using subsequent trapeziectomy
successfully relieves pain in patients in whom pyrocarbon arthroplasty has failed.
After revision, patients may lose abduction motion but have similar strength compared
with those who undergo primary trapeziectomy.
Type of study/level of evidence
Therapeutic III.
Key words
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Article info
Publication history
Published online: March 02, 2022
Accepted:
January 14,
2022
Received:
April 11,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
