Trapeziectomy or revision into a cemented polyethylene cup in failed trapeziometacarpal total joint arthroplasty

Objectives: Total joint replacement as treatment of osteoarthritis of the trapeziometacarpal joint may lead to excellent short-term results, but also with a high risk of failure of the trapezium component. The aim of this study was to compare revision using trapeziectomy with a revision into a cemented trapezium cup. Methods: Thirty-four patients with a mean follow-up time of 47 months were included in a case control study with 17 hands revised with a cemented cup and 21 trapeziectomy. Results: At follow-up, no significant difference was found in self-reported outcome, with pain at rest or activity and in grip strength comparing patients revised using trapeziectomy with patients revised with insertion of a new cup. There was, however, a high risk of re-revision in patients treated with insertion of a new cup and at the follow-up 4/17 cups had been re-revised and 5/17 cups had radiological signs of implant loosening. Conclusion: IT was found that trapeziectomy should be the standard salvage procedure after a failed trapezium implant and revision of cup loosening with a cemented cup has an unacceptable failure rate.