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Salvage Reconstruction of Failed Interposition Arthroplasty at the Base of the Thumb

Braun, Richard M. MD*; Rechnic, Mark MD; Shah, Kalpit N. BS

Techniques in Hand & Upper Extremity Surgery: December 2012 - Volume 16 - Issue 4 - p 230–235
doi: 10.1097/BTH.0b013e31826cf1bb
Techniques

We present an operative procedure designed to revise a failed arthroplasty at the base of the thumb. This report describes a reliable operation that corrects residual instability and malignment which results in thumbs that are weak and painful despite a previous procedure. The operation has also been used as a primary procedure for arthritis of the trapeziometacarpal joint where instability and subluxation was a major component of the problem requiring joint reconstruction. The unique features of this procedure include a reinforced double-thickness tendon graft, a unique tendon anchor, and a fascia lata allograft spacer. Significant functional improvement is anticipated when joint reconstruction provides increased proximal stability. Pinch and grip measurements improve. Pain scores also diminish after the operation. Hand function and patient satisfaction can be substantially improved with revision arthroplasty when the initial operation has failed to provide a thumb that is mobile, stable, and pain free. The technical features of the procedure address reduction of malignment, restoring of anatomic balance, and secure fixation of the proximal apex of the thumb metacarpal which restores thumb reduction position and digital balance.

*Department of Orthopaedic Surgery, University of California San Diego

School of Medicine, University of California, Irvine

Department of Plastic Surgery at University of California, San Diego, CA

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Richard M. Braun, MD, 770 Washington St. Suite 301, San Diego, CA 92103. E-mail: rbraun@handsrus.com.

© 2012 Lippincott Williams & Wilkins, Inc.