Surgical treatment after a failed trapeziectomy: A case report

Several treatment options exist to surgically treat end-stage trapeziometacarpal osteoarthritis. Trapeziectomy is recognized as leading to a mostly acceptable functional outcome. Although rarely encountered, persisting failure of the trapeziectomy is difficult to address. We present a case where several procedures were subsequently performed to treat a failed trapeziectomy condition. First, a trapeziometacarpal prosthesis (Arpe(®), Biomet(®)) was inserted with the two components reversed: the cup in the first metacarpal and the stem in the scaphoid. This prevented normal mobility and resulted in a non-functional, chronically painful joint. Revision arthroplasty was performed with a dual-mobility component (Ebony(®), Stryker(®)), replacing the trapezium to articulate with the first metacarpal and the scaphoid. This restored the first column's length but led to prosthesis instability only 4 months after implantation. Finally, first column arthrodesis with iliac bone graft interposed between the first metacarpal and scaphoid achieved an acceptable outcome.