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Journal of Hand Surgery

(European Volume)
Scaphometacarpal arthroplasty: a report 0(0) 1–5
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prosthesis and trapeziectomy revision DOI: 10.1177/1753193419900470
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Leo Chiche1,*, Herve Lamarre2, Stephane Barbary3 and

Jacques Teissier1

Abstract
Loosening of the trapezial component is a main cause of failure of trapeziometacarpal prostheses. This report
presents the preliminary results of scaphometacarpal prostheses used for revision of trapeziometacarpal
prostheses and failed trapeziectomies. A retrospective multicentre study was conducted on ten patients. Four
had revision surgery after failure of trapeziometacarpal prostheses, five after trapeziectomy and one after a
trapezial silicone implant. Pain, mobility, strength, QuickDASH, satisfaction score and radiographs were
assessed. Nine patients were assessed (one was lost to follow-up), with a mean follow-up of 34 months.
The mean pain score was 1.2/10, Quick-DASH was 39 and opposition according to the Kapandji score was 8.6.
Strength was 3 kg for key pinch and 13.6 kg for power grip. One failure was observed, with early loosening of
the scaphoid cup. Scaphometacarpal arthroplasty is a reliable medium-term solution for revision of the
loosening of a trapeziometacarpal prosthesis with trapezial damage and for failed trapeziectomy.

Level of evidence: IV

Keywords
Trapezio-metacarpal arthroplasty, carpometacarpal prosthesis revision, trapeziectomy revision, trapeziome-
tacarpal arthrosis

Date received: 16th June 2019; revised: 18th December 2019; accepted: 21st December 2019

shown good results (Kaszap et al., 2013; Lenoir

Introduction
For many years, trapeziectomy has been considered as
the reference standard for surgical treatment of tra-
peziometacarpal (TMC) joint osteoarthrosis, often
associated with various additional ligament recon-
structions, although there is no evidence of their
value (Wajon et al., 2015; Yeoman et al., 2019).
Prosthetic arthroplasty has shown very good results
in the short (Jager et al., 2013), middle and long terms
(Martin-Ferrero, 2014; Toffoli and Teissier, 2017), and
is increasingly used in France. One of the main reasons
for failure is loosening of the trapezial component
(Martin-Ferrero, 2014; Semere et al., 2015; Toffoli
and Teissier, 2017), and one of the main causes of tra-
peziectomy failure is impingement or instability of the
base of the thumb metacarpal.
There are few studies of the therapeutic options
available for surgical revision of these two proced-
ures. However, in cases of failure of a TMC prosthe-
sis, secondary trapeziectomy with interposition has
et al., 2016). Another option could be to implant a
prosthetic cup in the distal scaphoid, to produce a
scaphometacarpal arthroplasty. This option would
be suitable for failure of trapeziectomy, and also
loosening of the trapezial component of a prosthesis.
The aim of this study was to assess the functional,
clinical and radiological results of a scaphometacarpal
1
Unité main Orthosud, Clinique Saint Jean, Montpellier, France
2
Clinique Ambroise Paré, Thionville, France
3
Centre chirurgical ADR, Nancy, France
*Current affiliation: Service de chirurgie de la main et du membre
supérieur, CHU Lapeyronie, Montpellier, France
Corresponding Author:
Leo Chiche, Service de chirurgie de la main et du membre supér-
ieur, CHU Lapeyronie, 371 Avenue du doyen Gaston Giraud, 34000
Montpellier, France.
Email: leo.chiche@gmail.com
2 Journal of Hand Surgery (Eur) 0(0)
arthroplasty for revision of TMC joint arthroplasty and
trapeziectomy.
Methods
This was a retrospective multicentre study from
three hospitals.
Ten patients (nine women and one man) under-
went scaphometacarpal arthroplasty between May
2009 and July 2015. Their mean age was 74 years
(range 55–86) at the time of surgery. None of the
patients were working at that time. Four patients
had been treated with a TMC prosthesis, with sec-
ondarily loosening of the trapezial component and
destruction of the trapezium. Five had had trapeziect-
omy and ligamentoplasty, with a secondary painful
Z-deformity. One had trapeziectomy and silicone
implant, with subsequent trapezial osteolysis and
subluxation of the implant. All patients gave informed
consent.
Surgical procedure
The intervention was carried out under regional
anaesthesia, with a tourniquet placed at the upper
part of the limb. The approach was lateral, between
the abductor pollicis longus (APL) and the extensor
pollicis brevis tendons, taking care not to injure the
superficial branches of the radial nerve.
In revision after trapeziectomy, the thumb
metacarpal was prepared by removal of the base,
reaming the medullary canal with rasps and
implanting a stem (Figure 1). In the prosthesis
revision, we removed the neck with the head,
removed the trapezial cup and the rest of trapezium,
and when necessary removed the stem to implant a
new one.
A 9 mm semi-retaining cup was implanted into the
distal extremity of the scaphoid. Intraoperative test-
ing allowed us to choose the length of the neck
(offset long or extra long) (Figures 2 and 3). The
implants used were MAÏA implants (Groupe Lepine,
Lyon, France). Tenosynovectomy of the first compart-
ment of extensors was done in four cases. Capsular
closure was followed by tightening the APL and
reinserting it dorsally on the base of the thumb meta-
carpal. A postoperative splint was made to immobil-
ize the wrist and the metacarpophalangeal joint of
the thumb for 6 weeks.
Functional assessment
A self-assessment questionnaire was given to
patients, which included the scoring of pain from 0
to 10 on a visual analogue scale (VAS), overall
satisfaction (dissatisfied, satisfied, very satisfied)
and the QuickDASH questionnaire (Short-form
Disability of the Arm, Shoulder and Hand Survey).
Clinical assessment
All patients were clinically reviewed by an independ-
ent observer (LC). Thumb opposition and retropulsion
were measured using Kapandji scores (Kapandji,
1986). Range of motion included anteposition
(palmar abduction) and abduction (radial abduction)
for the TMC joint, and flexion/extension for the meta-
carpophalangeal (MCP) and interphalangeal joints.
Power grip and key pinch strength were measured
using a dynamometer. We looked for any residual
Z-deformity and when it existed, we tested the redu-
cibility of MCP hyperextension.
Radiological assessment
Radiological assessment consisted of anteroposter-
ior (AP) and profile views of the TMC joint, as
described by Kapandji et al. (1980), taken preopera-
tively, postoperatively and at the last follow-up. The
length of the first column was evaluated using the
ratio of Barron and Eaton (1998), comparing pre-
and postoperative radiographs.
Results
Clinical assessment
Nine patients had adequate follow-up. The mean
follow-up was 30 months (range 7–82). The mean
VAS pain score VAS was 1.2 (range 0–6). The
mean Quick-DASH was 39 (range 11–68).
Mean opposition and retropulsion scores were 8.6
(range 8–10) and 1.9 (range 1–3), respectively. Mean
range of motion of the TMC joint was 48 (SD 6 ) for
abduction and 40 (SD 7 ) for antepulsion. One patient
had a residual Z-deformity with 15 extension of the
MCP joint.
Mean pinch strength was 3 kg for pinch (contralat-
eral, 3.7 kg) and mean grip was 13.6 kg for grip
(contralateral, 15.8 kg).
Radiological assessment
There was one case of early loosening of the scaph-
oid cup (3 months after surgery). Three cases showed
slight osteolysis of the capitate bone, caused by abut-
ment in adduction. It was not clinically significant.
There were no other signs of radiolucency or implant
malposition. Measurement of the length of the first
column showed 10% shortening of the thumb for the
Chiche et al. 3

Figure 1. (a) Failed trapeziectomy with a Z-deformity. (b, c) Revision by scaphometacarpal prosthesis, associated with
metacarpophalangeal capsulodesis for correction of metacarpophalangeal hyperextension. Postoperative radiographs at
22 months follow-up.

Figure 2. (a) Cup loosening with destruction of the trapezium. (b, c) Revision by scaphometacarpal prosthesis.
Postoperative radiographs at 50 months follow-up.
4 Journal of Hand Surgery (Eur) 0(0)
Figure 3. Satisfactory radiological results at 6 years
follow-up.
TMC prosthesis revisions and 10% lengthening for
trapeziectomy revisions.
Postoperative complications
There was one dislocation after 5 years, which
required revision for lengthening of the neck, without
recurrence. As noted above, there was one failure
with early loosening of the scaphoid component,
which required revision for removal of implants
(only the cup and neck), making it the equivalent of
a secondary trapeziectomy. There were no post-
operative infections.
Discussion
This study showed good mid-term results for sca-
phometacarpal arthroplasty used for revision of
TMC prostheses and revision after trapeziectomy.
The MAÏA TMC prosthesis has already proved its effi-
cacy in surgical treatment of TMC osteoarthrosis,
when medical treatment is ineffective. A number of
studies have shown good results after 10 years of
follow-up, with a survival rate around 90% (Martin-
Ferrero, 2014; Toffoli and Teissier, 2017). The longest
follow-up reported to date is 12.5 years, with a 91%
survival rate (Semere et al., 2015).
The main reasons for failure of TMC joint pros-
theses are loosening of the trapezial component
and instability. Premature instability is usually
caused by implant malposition or poor healing of
soft tissues. If instability appears after many years,
it may be caused by erosion of the polyethylene,
which can be solved by changing only the polyethyl-
ene cup or the entire implant. When there is aseptic
loosening of the cup, various procedures can be
done: if the bone stock is adequate, a new cup can
be implanted, usually of a larger size, with or without
bone graft; in cases with insufficient bone stock, the
trapezium must be removed. Secondary trapeziect-
omy seems to be a reliable solution, but long-term
results are not yet available. Lenoir et al. (2016) pre-
sented good results at 30 months of follow-up in 12
cases of secondary trapeziectomy with tendon inter-
position. Kaszap et al. (2013) found no difference
between primary and secondary trapeziectomy.
Goorens et al. (2015) presented a case of scaphome-
tacarpal arthroplasty with the stem in the scaphoid
and cup in the first metacarpal, but persistent pain
led them to perform scaphometacarpal arthrodesis.
Many revision procedures for trapeziectomy fail-
ure have been described in small series.
Techniques include costochondral autograft (Glard
et al., 2006), pyrocarbon spacer interposition
(Bellemere, 2018), Swanson Silastic interposition
(Umarji et al., 2012), the Mini Tight-RopeÒ
EndoButton (Arthrex, Naples, FL) placed between
the thumb and index metacarpals (Braun et al.,
2016) and scaphometacarpal arthrodesis (Goorens
et al., 2015). However, there is no consensus on the
best procedure.
Our radiological assessment found a lengthening
of the first column after trapeziectomy revision that
seems to reduce hyperextension of the MCP joint
(Teissier et al., 2001).
Implantation on the distal part of the scaphoid
could induce scapholunate complex instability, lead-
ing to dorsal intercalated segment instability (DISI),
as can occur after resection of the distal pole of the
scaphoid (Garcia-Elias et al., 1999). We did not find
this deformity in our series, but AP and profile views
of the TMC joint do not allow for proper analysis of
the position of the lunate.
We had one case of loosening of the scaphoid cup
at 3 months, after the use of crutches. As the time
from surgery was very short, ‘non-osteointegration’
would be a more accurate term than ‘loosening’.
After removal of the implants (neck and cup), the
patient was able to return to leisure activities without
pain, but with decreased strength. This example
shows the possibility of implant removal in case of
failure of scaphometacarpal arthroplasty, equivalent
to a secondary trapeziectomy.
This study has several limitations: it was retro-
spective, investigating a small cohort, follow-up
was limited to 34 months, it was only descriptive
and there was no comparison with a control group.
Furthermore, several patients had a history of surgi-
cal treatment on the other hand, making comparison
with the contralateral side impossible.
However, it demonstrates the feasibility of this
scaphometacarpal arthroplasty. Precise criteria for
the indication for scaphometacarpal arthroplasty
Chiche et al.
are needed, the most important of which is insuffi-
cient trapezium bone stock in the trapezium, making
it impossible to replace the cup in TMC arthroplasty
revision. It is technically demanding to optimize the
centring and orientation of the cup (30 angle with the
index metacarpal in the frontal and sagittal plane).
Declaration of conflicting interests The authors
declared the following potential conflicts of interest with
respect to the research, authorship, and/or publication of
this article: Jacques Teissier has received royalties from
Lepine-Company for work related to the subject of this art-
icle. The other authors declared no potential conflicts of
interest with respect to the research, authorship, and/or
publication of this article.
Funding The authors received no financial support for the
research, authorship, and/or publication of this article.
Informed consent All patients gave informed consent.
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