Additional Surgery after Trapeziectomy with Ligament Reconstruction and Tendon Interposition: An 8 Year Follow-Up of 1369 Patients

Background: Trapeziectomy with Ligament Reconstruction and Tendon Interposition (LRTI) is a key treatment for thumb carpometacarpal (CMC-1) osteoarthritis (OA). Despite proven effectiveness, concerns remain about the need for revision surgery and its impact on long-term outcomes. Current literature lacks data on long-term rates of additional surgery. Therefore, this study evaluates long-term outcomes of trapeziectomy with LRTI in CMC-1 OA, focusing on revision rate. Methods: This multicenter prospective cohort study included patients who underwent trapeziectomy with LRTI (Weilby-sling, Burton-Pellegrini, or APL-sling) for CMC-1 OA between December 2011 and October 2021. The primary outcome was the rate of additional surgery beyond one year following LRTI, focusing on revision surgery. Secondary outcomes included prognostic factors for revision surgery, and long-term patient-reported outcomes (PROMs). Additionally, the impact of revision surgery on PROMS was assessed. Results: A total of 1369 patients were included, with a median follow-up of 7.8 years (range 3.1 to 13.0 years), of which 13% (95% Confidence Interval (CI): 11.3% to 14.9%) underwent additional surgery beyond one year. Revision surgery was required in 2.6% (95% CI: 1.7% to 3.5%). The APL-sling technique and younger age were associated with higher revision rates. PROMs improved significantly between 12 months and long-term follow-up, with revision surgery being associated with worse outcomes. Conclusions: Long-term follow-up revealed a 13% additional surgery rate, with 2.6% requiring revision surgery. We suggest that the APL-sling should be approached with caution. In younger patients, alternative treatments should be considered to postpone LRTI surgery and reduce revision risk. Level of evidence: Therapeutic, II