Resection arthroplasty

This salvage should be reserved for the failed implant arthroplasty, when there is a history of sepsis, in cases where bone stock is inadequate to provide implant fixation, or when soft tissue is deficient to provide implant stability. The principles of resection arthroplasty include sufficient bone resection to correct deformity and permit motion, and resurfacing or tissue interposition to prevent painful impingement or autofusion.

Though use of rib perichondrium has been described [6], it probably provides little advantage over other techniques with potentially less morbidity. Seradge and colleagues [6] reported on 16 MP joint perichondrial resurfacing arthroplasties, and showed an average total range of motion of only 22°. Further, in patients older than 30, unsatisfactory results were common.

A variety of techniques of resection arthro-plasty have been described. Resurfacing has used fascia lata [7]; extensor tendon, as described by Vainio [8]; volar plate, as described by Tupper

[9]; and extensor retinaculum [10]. From a practical standpoint, fascia lata harvest is not recommended, given the feasibility of alternative techniques, although use of allograft might be reasonable except for the added expense. The Tupper arthroplasty [9] is less likely to result in an MP joint extensor lag than when the extensor tendon [8] is used for interposition, but length of the volar plate may limit the amount of flexion that is possible after suturing it to the dorsal metacarpal surface (Fig. 2).

The authors prefer use of a relatively new technique described by Netscher and coworkers

[10], which uses extensor retinaculum (Fig. 3). The contour of the metacarpal head is maintained, providing, at least in theory, a more congruous arc of motion.

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