Characteristics of Patients Undergoing Revision Thumb CMC Arthroplasty

Abstract

Purpose The purpose of this study was to describe the demographic and operative characteristics of patients undergoing revision thumb carpometacarpal (CMC) arthroplasty and to characterize technique transitions from primary to revision surgery. Methods A retrospective review of revision thumb CMC arthroplasty cases was performed within a single health system from August 2015 to August 2025. Cases were identified by querying Current Procedural Terminology code 25447 and screening operative notes for revision-related terminology. For each case, primary and revision operative details were extracted, including reconstruction technique, interposition material, implant(s) used, and trapezium and/or trapezoid excision. Demographics, laterality, dominant hand, smoking status, and diabetes mellitus were recorded. Results Forty-two patients who underwent 54 ipsilateral revision thumb CMC arthroplasties were included. The cohort was predominantly women (79%) with a mean age at revision surgery of 62.9 ± 8.6. The median time from primary arthroplasty to first revision was 19 months (interquartile range, 10.9–43.2) with no difference by primary technique. Thirty-five patients (83%) underwent a single revision, six (14%) required two revisions, and one patient underwent seven revisions. The most common primary reconstruction techniques were flexor carpi radialis ligament reconstruction and tendon interposition (38%) and abductor pollicis longus suspensionplasty (33%), while suture-button suspensionplasty was used in only two cases (5%). Suture-button suspensionplasty was the most frequently performed revision technique (33%) followed by abductor pollicis longus suspensionplasty (19%). Approximately 95.2% (40/42) underwent a change in technique at revision. Partial trapezoid excision was performed in 4 of 42 (10%) primary procedures, and trapezoidectomy was performed in 12 of 54 (22%) revision procedures (11 partial, 1 complete). Conclusions Ninety-five percent of patients underwent a change in reconstruction technique at revision, and no single primary technique was immune to failure. Trapezoid excision was performed more than twice as often at revision, highlighting the role of adjacent joint pathology in the revision setting. Type of study/level of evidence Retrospective review IV.