Incidence of Implant-Related Complications After Tension Band Thumb Metacarpophalangeal Joint Arthrodesis

Abstract

Objectives: We sought to determine the incidence of hardware removal or persistent irritation after tension band arthrodesis of the thumb metacarpophalangeal joint (MCPJ), and whether these outcomes were related to patient age, gender, body mass index (BMI), or angle of fusion. Materials and Methods: A retrospective review was performed of all (n = 39) thumb MCPJ arthrodesis done using tension band wire fixation by a single hand surgeon at a large tertiary academic medical center over a 14-year period. Thirty procedures in 28 patients (4 men, 24 women) with an average age of 65 years (range, 35-81 years) were available for long-term follow-up (mean, 82 months; range, 12-171 months). Average BMI was 26.2 (range, 17.4-35).Most were done in conjunction with a basal joint suspensionplasty. Results: One hundred percent of arthrodesis healed radiographically at a mean 3.8 months (range, 3-7 months). Mean fusion angle was 24° (range, 9°-45°). Of patients available for long-term follow-up (n = 30), 7 (23%) required hardware removal for pain at a mean of 36 months postoperatively, and another needed revision of hardware at 4 months postoperatively. An additional 3 patients (10%) expressed dissatisfaction with the hardware in place, but declined removal. There was no significant influence of the above variables on hardware removal or dissatisfaction. Conclusions: Tension band wire arthrodesis of the thumb MCPJ results in predictable bony union. Although it is a very cheap means of fixation, there is a 33% incidence of significant hardware-related pain after tension band arthrodesis of the thumb MCPJ. Twenty-five percent of patients may require a second surgery to revise or remove symptomatic hardware, which can negate any cost savings through the use of this technique. A study comparing this method with plate or single screw fixation would be beneficial.