Increased Complications in Trapeziectomy With Ligament Reconstruction and Tendon Interposition Compared With Trapeziectomy Alone

Background: In the treatment of basal joint arthritis of the thumb, recent studies suggest equivalent outcomes with regard to long-term pain, mobility, and strength, in patients undergoing either trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI). The goal of this study was to investigate risk factors for complications in carpometacarpal (CMC) arthroplasty. Methods: We conducted a retrospective chart review of 5 surgeons at a single institution performing CMC arthroplasties from November 2006 to November 2012. A total of 200 thumbs in 179 patients underwent simple trapeziectomy with or without LRTI and with or without Kirschner wire stabilization, or a Weilby procedure. The average follow-up was 11.6 months (range = 1-69 months). Data collection included sex, age, history of smoking or diabetes, and any other surgeries performed on the hand at the time of arthroplasty. Furthermore, we collected outcomes involving any adverse events, paying attention to those necessitating reoperation, antibiotics, or those who developed complex regional pain syndrome. Results: Seventy hands had a postoperative complication. Ten of these complications were considered major, defined as requiring antibiotics, reoperation, or other aggressive interventions. On multivariate analysis, risk of total complications was significantly greater only in patients undergoing either trapeziectomy with LRTI or Weilby procedure in comparison with trapeziectomy with K-wire stabilization (odds ratio = 4.30 and 6.73, respectively). Conclusions: Patients undergoing trapeziectomy with LRTI or Weilby had a greater incidence of reported complications when compared with trapeziectomy alone. These results suggest an advantage of simple trapeziectomy; however, further study is warranted.