Salvage Arthrodesis after Failed Trapeziometacarpal Total Joint Replacement: A Technical Note

In cases of failure of trapeziometacarpal total joint replacements, we have chosen a different strategy than trapeziectomy for high-demand patients (or patients dissatisfied with a contralateral previous trapeziectomy), performing a trapeziometacarpal arthrodesis with an interposed corticocancellous iliac crest graft. This article aims to describe the technique and report our results in three patients. Median age at revision arthrodesis was 60 years. The stems were removed with a dorsal bone-lid, leaving a defect into which the bone graft was fitted and fixed with cortical screws before impaction of the graft into the trapezial remnant with K-wire fixation proximally. Cast immobilisation was used for 8 weeks. At final follow-up, all fusions had healed, and patients were satisfied according to strength measurements and PROMs. While further validation in a larger cohort with longer follow-up is required, we believe the technique may be of value, particularly in high-demand patients. Level of Evidence: Level V (Therapeutic).