Early to Mid-Term Results in Trapezio-metacarpal Joint Replacement using the ARPE Implant

Abstract

Trapezio-Metacarpal Joint (TMJ) arthritis is a common cause of radial sided wrist pain. After conservative measures have been exhausted, the current mainstay of surgical treatment is trapeziectomy. Some surgeons combine this with additional ligament reconstruction and tendon or capsular interposition techniques to provide a more stable base for the thumb metacarpal. In modern Orthopaedic practice, arthroplasty is the procedure of choice for many end-stage arthritic joints. However, due to the reliable and reproducible outcomes of trapeziectomy, this has yet to be widely adopted by hand surgeons in the management of TMJ arthritis. Recent series of arthroplasty implants have consistently shown good outcomes and trapezio-metacarpal joint replacement has been observed to provide excellent long-term function in the fit and active patient. We have performed a total of 52 TMJ arthroplasties in 46 patients in our institution for over 5 years (2011 to 2016). After excluding 3 cases, 43 available patients (49 implants) were subsequently asked to submit QuickDASH scores and a patient satisfaction survey. Average QuickDASH score was 16.6, with high patient satisfaction postoperatively at 1 year. Complications included one intraoperative fracture, and five cases of post-operative instability/ dislocation. Dislocations were treated successfully with open reduction and revision. TMJ arthroplasty has shown good outcomes and patient satisfaction with a low revision rate and we recommend its use in active patients with well-preserved scapho-trapezio-trapezoid (STT) joints.