Trapézectomie secondaire après échec de prothèse trapézo-métacarpienne - 25/11/18
Résumé |
Basal thumb arthroplasty is a commonly performed procedure to treat trapeziometacarpal (TMC) arthritis. The risk of failure is highly fluctuating in the literature, and only few report the functional results of secondary trapeziectomy resulting from failed joint replacement. We aim to describe our large series of patients with secondary trapeziectomy. Retrospective study of 32 patients undergoing secondary trapeziectomy after failed TMC arthroplasty with a mean follow-up of 48.8 months (±26.8). We realized an objective evaluation of the mobility of the thumb and the strength of the hand, a subjective evaluation with visual analogic scales and DASH questionnaire, and a radiologic evaluation to assess the thumb shortening. The mean age at revision surgery is 62 years old, and is composed of 28 women for 4 men. The survival of the prosthesis is 19.5 months, and not reaching one year in 66% of the cases. The major indications for revision were loosening of the trapezial implant in 56% of the cases, and luxation of the prosthesis in 22%. The handgrip strengths of the 2 hands are comparable, as well as the key pinch strength (P<0.000). The Kapandji score reached 9.4±1 10 and was associated with an adequate measured mobility of the thumb. The vast majority of the patients were satisfied or very satisfied by the revision surgery (respectively 32% and 53% of the patients). The mean DASH score attains 22.6±17.6 100. The mean Barron Eaton's height ratio reached 0.61±0.04 on the injured side and 0.55±0.07 on the opposite hand, the length difference was not significantly different and did not impact significantly clinical function of the thumb (pain, mobility, strength) (P<0.000). Secondary trapeziectomy is a very efficient rescue procedure that gives good functional results with high satisfaction rates. These data lead us to accept the risk of failure of TMC joint arthroplasty that can be salvaged with a reliable procedure that gives replicable postoperative results.
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Vol 37 - N° 6
P. 404 - décembre 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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