[Endoprosthetics in Revision Surgeries on the Thumb Carpometacarpal Joint: Pearls and Pitfalls, Off-label Use, and...

Trapeziometacarpal (TMC) joint arthroplasty has become an established and effective treatment option for advanced trapeziometacarpal osteoarthritis. Prosthetic replacement can also be employed in revision procedures following failed surgeries involving the trapezium or the base of the first metacarpal. Revision arthroplasty is technically demanding, as altered anatomical conditions, scar tissue, and compromised bone quality may complicate implantation. Patients and Surgical Techniques Based on specific cases, we present indications and techniques for revision arthroplasty of the TMC joint, including prosthesis implantation after malunited Bennett or Rolando fractures, persistent TMC joint dislocation, proximal migration of the first ray following trapeziectomy with scaphometacarpal implantation of the endoprosthesis, as well as procedures addressing osseous defects of the trapezium after previous prosthesis implantation.In five patients with post-traumatic osteoarthritis, implantation of a TMC endoprosthesis resulted in pain relief and functional restoration. Twelve patients treated with scaphometacarpal implantation after trapeziectomy consistently achieved sufficient pain reduction and recovery of hand function; overall patient satisfaction was high. In one additional case, the trapezium was reconstructed using a tricortical iliac crest graft, enabling reimplantation of the prosthetic cup. No major short-term complications were observed.In our cohort, TMC joint arthroplasty proved to be an effective revision option not only for post-traumatic conditions but also for proximal migration of the first ray following trapeziectomy. Success depends on adapting the procedure to the specific anatomical and biomechanical conditions of the previously operated joint. Surgeons should have solid experience with primary TMC arthroplasty before attempting revision cases. Further clinical studies are required to compare prosthesis implantation with established salvage procedures such as trapeziectomy or arthrodesis.