[Salvage procedure for painful proximalisation of the 1st metacarpal after trapeziectomy using the Mini TightRope®].

PURPOSE: This study analyses our results after revision surgery for failed trapezectomy and suspension arthroplasty with painful proximalisation of the 1(st) metacarpal using the Mini TightRope(®).

PATIENTS AND METHODS: In a prospective observational study, 5 patients (4 women and 1 man) with an average age of 62 years were treated with the Mini TightRope(®) for revision of a failed Epping arthroplasty with painful proximalisation of the first ray. The mean time between initial surgery and revision was 23.1 (12.5-31.5) months; the mean follow-up was 25±7.7 (12-32) months. The pain level (visual analogue scale - VAS), pinch grip, and qDASH score were evaluated preoperatively and postoperatively. In addition, the Conolly score was used postoperatively. Directly after surgery and at the last follow-up exam, the degree of proximalisation of the first metacarpal was measured radiologically.

RESULTS: At the last follow-up, there was significant mean pain relief during everyday stress, from 5.2 preoperatively to 1.6 (p<0.01) postoperatively, and a significant increase in pinch grip, from 0.5 kg to 3 kg (p<0.01). qDASH improved significantly, from 54 to 20 (p<0.001). The Conolly score showed 2 good and 3 fair results. Renewed proximalisation could not be entirely prevented, but was limited to an average of 2 mm.

CONCLUSION: Mini TightRope(®) revision surgery after failed trapezectomy and suspension arthroplasty showes good results with significant pain reduction and gain of function. Renewed proximalisation of the first ray cannot be completely avoided.