Diagnostic and treatment recommendations for recurrent or persistent symptoms after trapeziectomy: a Delphi study.

Abstract

The aim of this Delphi study was to provide a diagnostic and treatment algorithm for patients with persistent or recurrent symptoms after trapeziometacarpal joint resection arthroplasty. Three Delphi rounds were conducted in which surveys were sent to 182 experienced hand surgeons worldwide. Responses were received from 140 participants. A consensus threshold was set at 67% agreement. Diagnostic tools and treatment approaches for six common revision scenarios achieved consensus. Radiographs are appropriate as primary (97%) and CT scans as secondary (76%) diagnostic tools. For scaphometacarpal impingement, 67% of respondents agreed that revision interposition is appropriate, with 93% recommending autologous tendon for the interposition. Additional suspension was considered appropriate by 68% of the participants. The diagnostic and treatment algorithm can help the surgeon to identify the reason for persistent symptoms after trapeziometacarpal joint resection arthroplasty and to choose an appropriate treatment strategy.Level of evidence: V.