Revision surgery after resection arthroplasty of the thumb saddle joint

Abstract

Resection arthroplasty still is the gold standard for the treatment of basal thumb arthritis. In most patients, satisfactory results can be expected. However, the few patients with persisting problems are achallenge for the hand surgeon. They may complain of neuromas, tendinitis of the flexor carpi radialis (FCR) tendon, impingement and/or proximalization of the first metacarpal, arthritis of the scaphotrapezoidal joint or carpal collapse in the case of pre-existing scapholunate instability. This includes subtle clinical examination. Radiography may be completed by a CT scan. Probational infiltration is ahelpful tool to confirm diagnosis and may be the first step of aconservative treatment, when supplemented by orthoses. Revision surgery is guided by the nature of the present problem. Neurolysis should be indicated cautiously and performed according to existing principles. FCR tendinitis is treated by release or resection of the tendon. Impingement of the first metacarpal is treated by repeat resection and tendon interposition, proximalization by additional suspension arthroplasty or by arthrodesis between the bases of the first and second metacarpals. In the case of scaphotrapezoidal arthritis, the proximal third of the trapezoid is resected, whereas destabilization of the scaphoid with consecutive carpal collapse may necessitate midcarpal fusion.