Outcomes of Secondary Trapeziectomy Following Carpometacarpal Pyrocarbon Prosthetic Arthroplasty

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.