Complications and failures of the trapeziometacarpal Maia prosthesis: A series of 156 cases.

When implanting the Maia trapeziometacarpal prosthesis, surgeons will be faced with a variety of complications they must be able to recognize and anticipate. Their ability to deal with these complications and possibly even failures is governed by their knowledge of the right steps to take. The aim of this retrospective study was to assess the incidence of complications reported during implantation of the Maia prosthesis, to describe their nature and potential predisposing factors, and to study failures and their outcomes. Between January 2008 and December 2012, 156 Maia prosthetic joints were implanted in 139 patients at one center by one surgeon. Clinical and radiological parameters were analyzed before, during and after surgery. The implant characteristics were documented and the surgical technique used was analyzed. The overall postoperative complication rate was 35.9%. The most common complication (16%) was tendinopathy. Prosthesis dislocation (4.5%) and trapezoid loosening (2.6%) were the primary causes of failure. Eighteen patients required secondary surgical revision (11.5%) and the implant was removed in 12 cases (failure rate of 7.7%). Two factors were significantly correlated with the onset of complications, independent of their nature and irrespective of whether secondary surgical revision was required: a deformed thumb prior to surgery and the position of the trapezial cup. Mediocre trapezium bone quality was a statistically significant factor for secondary surgical revision. The survival rate of the Maia prosthesis was 90.8% at 62months. These factors influence the onset of complications and must be taken into account in the pre-surgical workup in order to identify the best candidates for successful Maia joint replacement. For the most part, the failure rate in our series was due to inappropriate surgical technique rather than an inherent defect in the prosthesis. A meticulous, precise surgical technique is therefore essential.