1
|
Claxton MR, Rode MM, Wagner ER, Moran SL, Rizzo M. Metacarpophalangeal Joint Pyrocarbon Arthroplasty for Osteoarthritis: An Analysis of 44 Arthroplasties. J Hand Surg Am 2024; 49:450-458. [PMID: 36243595 DOI: 10.1016/j.jhsa.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/13/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The objective of this study was to analyze postoperative outcomes in a group of patients who underwent metacarpophalangeal (MCP) arthroplasty using a pyrocarbon prosthesis for noninflammatory arthritis. METHODS An analysis of 44 MCP joint arthroplasties in 30 patients with >2 years of follow-up over a 12-year period was reviewed. The mean age was 63 years. The primary operative indication was pain and stiffness from osteoarthritis refractory to nonsurgical management. RESULTS At a mean follow-up of 6 ± 3 years, 8 (18%) joints underwent reoperation, including 5 (11%) that underwent revision arthroplasty. The 2- and 5-year rates for survival free of revision arthroplasty were 95% and 93%, respectively. One (2%) operation was complicated by intraoperative fracture. Postoperative complications occurred in 8 (18%) fingers and included ligament/tendon rupture (n = 3) and instability (n = 2). There was significant postoperative improvement in pain levels, MCP arc of motion, pinch strength, and grip strength. At a mean 5 years of radiographic follow-up, 7% had progressive implant instability because of grade 3 or greater loosening. No joints experienced implant instability from progressive subsidence. CONCLUSIONS Metacarpophalangeal arthroplasty using a pyrocarbon implant for osteoarthritis demonstrates an 7% revision rate at 5 years after surgery. Complications lead to reoperation in 1 of 5 arthroplasties. Radiographic evidence of implant instability was uncommon. Overall, patients experienced predictable pain relief and improvements in their range of motion and pinch strength. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
| | - Matthew M Rode
- Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
| | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
2
|
Rizzo M, Chung KC. What Plastic Surgeons Should Know about Small-Joint Arthroplasty: Is This for Your Practice? Plast Reconstr Surg 2024; 153:373e-382e. [PMID: 37189228 DOI: 10.1097/prs.0000000000010693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
SUMMARY This article reviews the state of the art for arthroplasty of the metacarpophalangeal and proximal interphalangeal joints. Arthritis that affects these joints can result in significant pain and compromised function. The authors review indications for arthroplasty for each joint, types of implants to consider, technical considerations, patient expectations, and outcomes and complications.
Collapse
Affiliation(s)
- Marco Rizzo
- From the Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| |
Collapse
|
3
|
Abstract
Background: Current recommendations for osteoarthritis of the metacarpophalangeal joint (MCPJ) are confined to implant arthroplasty to preserve joint motion and provide pain relief. This study documents the median 2-year results of a novel soft tissue arthroplasty technique that interposes the dorsal capsule. Methods: A retrospective review of 10 MCPJ dorsal capsule interposition arthroplasties in 8 patients was conducted. Physical evaluation assessed MCPJ range of motion (ROM), grip strength, and pain. Outcome tests used were the Michigan Hand Outcome Score, Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Kellgren and Lawrence Classification assessed severity of MCPJ osteoarthritis on preoperative radiographs. Results: The mean follow-up was 29 months from surgery. Average VAS was 2/10 postoperatively and average postoperative ROM improved 7 degrees. Average postoperative grip strength of the surgical hand was 30 kg. The QuickDASH average score was 24. Average Michigan Hand Questionnaire final score was 70. Patients with Kellgren Grades 2 or 3 osteoarthritis had the best QuickDASH and Michigan Hand Outcome scores. All patients working before surgery returned to work. No patient required a second surgery. Conclusion: This technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years. Pain relief was most reliably provided in patients with less severe radiograph findings. The advantages of this procedure include preservation of bony anatomy, collateral ligaments, and volar plate to not preclude later implant arthroplasty.
Collapse
Affiliation(s)
| | | | - Jeffrey A. Marchessault
- East Tennessee State University, Kingsport, USA
- Associated Orthopaedics of Kingsport, TN, USA
| |
Collapse
|
4
|
Cefalu CA, Blazar PE, Simmons BP, Earp BE. Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint. Hand (N Y) 2021; 16:632-637. [PMID: 31578890 PMCID: PMC8461196 DOI: 10.1177/1558944719878841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.
Collapse
Affiliation(s)
- Charles A. Cefalu
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA,Charles A. Cefalu, Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA.
| | - Philip E. Blazar
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Barry P. Simmons
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Brandon E. Earp
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Xie F, Lan X, Lin J. Arthroplasty for Treating Traumatic Metacarpophalangeal Joint Defects: A Retrospective Study Over Three Years. J Pain Res 2021; 14:1457-1464. [PMID: 34093036 PMCID: PMC8168832 DOI: 10.2147/jpr.s299135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Bone loss at the metacarpophalangeal joint (MCP) after trauma is difficult to treat. Objective We aimed to investigate the effectiveness of Swanson's arthroplasty and the reason for implant fracture. Methods We retrospectively analyzed the data of 175 patients who underwent emergency MCP arthroplasty between 2013 and 2016. Some patients used a orthosis to limit the radioulnar movement of the metacarpal joint for eight weeks after surgery (Group A), while the other patients underwent only hand rehabilitation after surgery (Group B). The basic information and perioperative data of the patients were compared. The patients were followed up clinically for an average of 65±19 months. Postoperative and follow-up complications and functional parameters were recorded and compared. Stress model of implant fracture had been analyzed in order to mark the frequent area. Results A total of 162 patients were followed up, 4 of whom were lost to follow-up completely and 9 of whom were followed up by telephone only. There were 11 and 26 implant fractures in groups A and B, respectively (P=0.019), and the degrees of radioulnar movement were 2±1° and 7±4°, respectively (P<0.01). The disabilities of the arm, shoulder, and hand (DASH) score and MCP joint range of motion (ROM) did not significantly differ. Conclusion The effect of Swanson’s arthroplasty for bone loss at MCP joint is useful. The radioulnar stress may be the reason for implant fracture. Joint orthosis can reduce the incidence of implant fractures.
Collapse
Affiliation(s)
- Fei Xie
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian, 350004, People's Republic of China
| | - Xianfeng Lan
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian, 350004, People's Republic of China
| | - Jingui Lin
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian, 350004, People's Republic of China
| |
Collapse
|
6
|
Billig JI, Nasser JS, Chung KC. National Prevalence of Complications and Cost of Small Joint Arthroplasty for Hand Osteoarthritis and Post-Traumatic Arthritis. J Hand Surg Am 2020; 45:553.e1-553.e12. [PMID: 31924436 DOI: 10.1016/j.jhsa.2019.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/13/2019] [Accepted: 11/05/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Osteoarthritis (OA) of the hand is commonly treated using implant arthroplasty. Despite the increasing prevalence of hand OA, population-based evidence regarding the complication profile and associated cost for patients undergoing proximal interphalangeal (PIP) joint and metacarpophalangeal (MCP) joint arthroplasty are lacking. Therefore, we aimed to evaluate the complication profiles and variation in cost of care for patients undergoing PIP and MCP joint arthroplasty. METHODS We analyzed insurance claims from 2009 to 2016 using the Truven MarketScan Databases for adult patients undergoing a PIP and MCP joint arthroplasty following OA or post-traumatic arthritis diagnosis. Multivariable logistic regression was performed to investigate the association of patient-level factors and complications at 2 years after surgery. Cumulative direct cost, defined as the cost of the index surgery and 2-year postoperative episode, and patient-level characteristics were examined. RESULTS We analyzed a total of 2,859 patients who underwent MCP joint arthroplasty (36%) or PIP joint arthroplasty (64%). On average, these procedures have a 35% complication rate. However, patients undergoing PIP joint arthroplasty were more likely to suffer a prosthetic fracture than patients undergoing MCP joint arthroplasty (3.4% vs 1.5%, respectively). Each complication resulted in an additional cost of $1,076. CONCLUSIONS This nationwide analysis provides a population estimate of the complication profile and associated costs of MCP and PIP joint arthroplasty for hand OA and post-traumatic arthritis. Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Jessica I Billig
- VA/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Jacob S Nasser
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI.
| |
Collapse
|
7
|
Abstract
Arthritis of the thumb metacarpophalangeal joint can be debilitating whether in isolation or in conjunction with degenerative disease at the adjacent joints. Despite its crucial role in fluid and dexterous motion of the thumb axis, little is known about the isolated incidence of pathology at this joint. Etiologies include primary, posttraumatic, and inflammatory arthritis. For early, isolated degenerative disease, arthroscopic synovectomy has been shown to yield satisfactory results. For more advanced disease, fusion is the benchmark. The literature suggests that increased flexion angles may mitigate development of trapeziometacarpal arthritis. In case of advanced arthropathy of the entire thumb axis, arthroplasty is a viable option to reduce pain, preserve motion, and thus limit progression of adjacent joint disease. Special considerations should be given to the rheumatoid thumb because a select combination of treatments for each deformity is thought to best address the unique pathomechanics.
Collapse
|
8
|
Index Finger Metacarpophalangeal Joint Arthrodesis With a Dorsal Locking Plate. Tech Hand Up Extrem Surg 2019; 24:47-52. [PMID: 31693572 DOI: 10.1097/bth.0000000000000270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Index finger metacarpophalangeal (MCP) joint arthrodesis is a potential reconstructive option for recalcitrant MCP arthritis. Due to lateral forces applied by the thumb, our institutional experience supports index finger MCP arthrodesis as a successful option in younger, higher demand patients and in the setting of significant joint instability. We present our technique of performing index finger MCP arthrodesis using a dorsal locking plate. The proposed benefits of this technique include the ability to position the MCP joint in the desired degree of flexion, generation of parallel fusion surfaces with even compression across the arthrodesis site, and stable fixation.
Collapse
|
9
|
Naghshineh N, Goyal K, Giugale JM, Neral MK, Ferreira JV, Buterbaugh GA, Imbriglia JE. Proximal Interphalangeal Joint Silicone Arthroplasty for Osteoarthritis: Midterm Outcomes. Hand (N Y) 2019; 14:664-668. [PMID: 29619888 PMCID: PMC6759980 DOI: 10.1177/1558944718769427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Osteoarthritis of the proximal interphalangeal (PIP) joint affects a large percentage of the population and can lead to significant functional disability. The purpose of this study is to evaluate the midterm clinical effectiveness of PIP joint arthroplasty for nonrheumatic arthritis. Methods: A single-center retrospective cohort study evaluating preoperative and postoperative objective and subjective measures was conducted. Range of motion (ROM), Disabilities of the Arm, Shoulder and Hand scores, key pinch strength, grip strength, and satisfaction with respect to pain, deformity, function, and strength were measured. Results: Forty-five fingers in 25 patients were followed up for a mean period of 42 months. Preoperative and postoperative mean ROM was equivalent at 59.1° and 59.2°, respectively. Postoperative grip and key pinch strength showed significant improvement and near normalization compared with contralateral extremity. Complication rate was 37% with 20% requiring revision surgery. Patients with diabetes mellitus had higher odds of requiring revision surgery. Pain scores improved from 7.4 to 1.9 on a visual analog scale. Overall satisfaction was high at 84%, and 91% of patients would have the surgery performed again. Conclusions: Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. Our study presents midterm follow-up data that support significant pain relief, increased grip and key pinch strength, and high satisfaction associated with this implant.
Collapse
Affiliation(s)
| | - Kanu Goyal
- The Ohio State University, Columbus,
USA
| | - Juan M. Giugale
- University of Pittsburgh Medical Center,
PA, USA
- Juan M. Giugale, Department of Orthopedics,
University of Pittsburgh Medical Center, Medical Building T, 5th floor, 9104
Babcock Boulevard, Pittsburgh, PA 15213, USA.
| | | | | | | | | |
Collapse
|
10
|
Abstract
PURPOSE The objective was to examine outcomes associated with a large cohort of revision metacarpophalangeal (MCP) arthroplasties. METHODS A review of 128 revision MCP arthroplasties performed in 64 patients was performed. The mean age at surgery was 62 years. Fifty nonconstrained (31 pyrocarbon and 19 surface-replacing arthroplasty) and 78 constrained silicone implants were used for revisions. RESULTS At a follow-up of 6 years (2 to 16), 20 (16%) implants required a secondary revision surgery. The 5- and 10-year survival rates were 81% and 79%, respectively. Postoperative dislocation occurred in 17 (13%) MCP joints. Subgroup analysis demonstrated a 5-year survival rate of 67% in surface-replacing arthroplasties, compared with 83% for both pyrocarbon and silicone implants (hazard ratio, 2.60; P = 0.09). Clinical improvements in pain and MCP range of motion were noted in most patients postoperatively. CONCLUSIONS Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations. However, most patients who did not undergo a secondary revision surgery experienced improvements in pain and range of motion. Worse outcomes are seen in patients with a history of MCP dislocations. LEVEL OF EVIDENCE Level IV.
Collapse
|
11
|
Boe C, Wagner E, Rizzo M. Long-term outcomes of silicone metacarpophalangeal arthroplasty: a longitudinal analysis of 325 cases. J Hand Surg Eur Vol 2018; 43:1076-1082. [PMID: 29848135 DOI: 10.1177/1753193418778461] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An analysis was conducted of 325 consecutive metacarpophalangeal arthroplasties prospectively collected using a single institution's total joints registry over a 14-year time period to characterize long-term radiographic and functional outcomes. Patients were followed for a mean of 7.2 years (2-18) or until revision. The 5-, 10- and 15-year survival free from revision were 98%, 95% and 95%, respectively. The 5-, 10- and 15-year survival rates free from radiographic implant fracture were 93%, 58% and 35%, respectively. The 5-, 10- and 15-year survival rates free from coronal plane deformity greater than 10° were 81%, 37% and 17%, respectively. Patients had significant improvements in their postoperative pain levels and metacarpophalangeal arc of motion. Neither implant fracture, nor coronal plane deformity >10° had a significant association with worse function. Overall, pain relief and functional improvement are reliable, though silicone implants do not protect from progression of coronal plane deformity and have a high fracture rate. Level of evidence: IV.
Collapse
|
12
|
Karl Spies C, Langer M, Hahn P, Peter Müller L, Unglaub F. The Treatment of Primary Arthritis of the Finger and Thumb Joint. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:269-275. [PMID: 29739493 PMCID: PMC5954171 DOI: 10.3238/arztebl.2018.0269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/15/2017] [Accepted: 01/31/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary finger and thumb joint arthritis is common, with a markedly rising prevalence from age 50 onward. As the population as a whole ages, the need for effective, stage-appropriate treatment of this condition is increasing. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane Library databases. RESULTS Pain on movement and morning stiffness are commonly reported symptoms. Thorough physical examination and plain x-rays are mandatory. In the early stages of primary finger and thumb joint arthritis, a conservative, multimodal treatment approach involving the use of splints, physiotherapy, and non-steroidal anti-inflammatory drugs can be helpful. The intraarticular injection of hyaluronic acid or cortisone seems to relieve pain in the short term, but its long-term efficacy in primary finger and thumb joint arthritis is questionable. Arthrodesis (joint fusion) is a reliable surgical treatment option for arthritis of the metacarpophalangeal and interphalangeal joints of the thumb. For mobility-preserving surgery of the metacarpophalangeal joints of the second through fifth fingers, silicone implant arthroplasty remains the gold standard. Symptomatic, advanced arthritis of the distal interphalangeal joint is most effectively treated with arthrodesis. CONCLUSION The efficacy of conservative treatment has been documented in high-quality clinical trials, while that of surgical treatment has not. The various surgical methods have yielded benefits in routine clinical use, but these remain to be assessed in randomized and controlled trials.
Collapse
Affiliation(s)
| | - Martin Langer
- Department of Trauma, Hand, and Plastic Surgery, Münster University Hospital, Münster
| | - Peter Hahn
- Department of Hand Surgery, Vulpius Hospital, Bad Rappenau
| | - Lars Peter Müller
- Department of Orthopedics and Trauma Surgery, Cologne University Hospital, Cologne
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Hospital, Bad Rappenau
- Medical Faculty Mannheim, University of Heidelberg, Mannheim
| |
Collapse
|
13
|
Morrell NT, Weiss APC. Silicone Metacarpophalangeal Arthroplasty for Osteoarthritis: Long-Term Results. J Hand Surg Am 2018; 43:229-233. [PMID: 29146506 DOI: 10.1016/j.jhsa.2017.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To demonstrate that silicone metacarpophalangeal (MCP) arthroplasty provides excellent long-term outcomes with a low complication rate in osteoarthritis patients. METHODS A consecutive cohort of 35 patients with osteoarthritis of 1 or more MCP joints undergoing anatomically neutral silicone MCP arthroplasty was followed over a 15-year period. Functional outcomes including strength and range of motion (ROM), as well as complications, were recorded. All patients were available for long-term assessment including radiographs and outcomes questionnaire. RESULTS Average follow-up for the cohort of 35 patients (40 implants) was 8.3 years (range, 2-17 years). Average age was 58 years (range, 42-80 years) with 22 men and 13 women. In 31 patients, a single MCP joint was involved (middle finger, 20; index finger, 10; little finger, 1). The dominant hand was involved in 23 patients. Seven (of 14) patients had a concomitant RCL reconstruction of the index finger MCP joint; no other digit had a collateral ligament reconstruction. Average final visual analog scale pain score was 0.3 of 10. Average final active ROM arc was from 4° (range, 0°-20°) to 73° (range, 50°-90°) of flexion. One patient had a revision MCP arthroplasty for a 97% clinical survivorship. Radiographs demonstrated fractured implants in 5 of 40 (12.5%) implants, but none exhibited instability, pain, or ROM deterioration. Average Michigan Hand Outcomes Questionnaire score was 82 (of 100) at final follow-up. CONCLUSIONS Silicone arthroplasty is effective in the treatment of primary MCP osteoarthritis. Implant survivorship is 97% (clinical) and 88% (radiographic) in long-term follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Nathan T Morrell
- Department of Orthopaedics, University of Vermont, Burlington, VT
| | - Arnold-Peter C Weiss
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI.
| |
Collapse
|
14
|
Lans J, Machol JA, Deml C, Chen NC, Jupiter JB. Nonrheumatoid Arthritis of the Hand. J Hand Surg Am 2018; 43:61-67. [PMID: 29132785 DOI: 10.1016/j.jhsa.2017.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/18/2017] [Indexed: 02/02/2023]
Abstract
Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid hand arthropathies is beneficial for clinicians to recognize these problems.
Collapse
Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Jacques A Machol
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christian Deml
- Department of Trauma Surgery, Division of Hand and Wrist Surgery, Medical University of Innsbruck, Austria
| | - Neal C Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jesse B Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
15
|
Srnec JJ, Wagner ER, Rizzo M. Implant Arthroplasty for Proximal Interphalangeal, Metacarpophalangeal, and Trapeziometacarpal Joint Degeneration. J Hand Surg Am 2017; 42:817-825. [PMID: 28869061 DOI: 10.1016/j.jhsa.2017.07.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 07/25/2017] [Indexed: 02/02/2023]
Abstract
Arthritis of the hand can result from inflammatory arthritis, osteoarthritis (OA), or be posttraumatic and can cause pain and debilitation. Arthroplasty serves as 1 surgical option in the surgical management of arthritis and aims to create a pain-free joint with preservation of motion. Although implant arthroplasty of the proximal interphalangeal (PIP), metacarpophalangeal (MCP), and trapeziometacarpal (TMC) joints predictably produce pain relief and high satisfaction, it has historically suffered from high rates of complications. The hinged silicone prosthesis was 1 of the early implants and, in many cases, remains the gold standard. However, problems with deformity correction, implant fracture, and synovitis remain. Implants made of alternative materials such as metal-plastic and pyrocarbon have evolved; however, survivorship and reoperation rates remain a concern. This review details the evolution and current options available for small joint implant arthroplasty involving the MCP, PIP, and TMC joints.
Collapse
Affiliation(s)
- Jason J Srnec
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Eric R Wagner
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Marco Rizzo
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
16
|
Abstract
BACKGROUND Giant cell tumor (GCT) of bone is a benign, though locally aggressive tumor, classically described as an eccentric lytic lesion, often with cortical expansion and destruction. It typically involves the metaphysis or epiphysis of long bones in skeletally mature patients, with a slight female predominance. The incidence in the small bones of the hand has been reported to be 2% to 5%. METHODS Treatment options have evolved in recent years, and currently include intralesional curettage with or without adjuvant therapy, wide resection, and occasionally amputation. RESULTS In this report, we present a long-term follow-up (10 years) of a patient with GCT involving a metacarpal, who was initially reconstructed with a metacarpal head allograft, which was eventually revised to a metacarpophalangeal (MCP) total joint arthroplasty. CONCLUSIONS To our knowledge, this is the only report of pyrocarbon being used for tumor reconstruction and the only report of late MCP allograft salvage.
Collapse
Affiliation(s)
| | | | - Steven L. Moran
- Mayo Clinic, Rochester, MN, USA,Steven L. Moran, Department of Orthopedic Surgery and Division of Plastic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
17
|
Martin AS, Awan HM. Metacarpophalangeal Arthroplasty for Osteoarthritis. J Hand Surg Am 2015; 40:1871-2. [PMID: 26162229 DOI: 10.1016/j.jhsa.2015.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/24/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Adam S Martin
- Hand and Upper Extremity Center, Department of Orthopaedics, The Ohio State University, Columbus, OH
| | - Hisham M Awan
- Hand and Upper Extremity Center, Department of Orthopaedics, The Ohio State University, Columbus, OH.
| |
Collapse
|
18
|
Papalia R, Tecame A, Torre G, D'Adamio S, Maffulli N, Denaro V. Small joints replacement for hand osteoarthritis: a systematic review. Br Med Bull 2015; 116:55-68. [PMID: 25990961 DOI: 10.1093/bmb/ldv024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Small joints replacement is a valid treatment for moderate to severe osteoarthritis of the hand. Several design and materials are now available for prostethic procedures with very different clinical and functional outcomes. SOURCES OF DATA An online search was carried out using Medline, Cochrane and Google scholar online databases, searching for studies on small joints replacement in hand surgery. AREAS OF AGREEMENT Good functional and clinical outcomes can be achieved with silicone and pyrolitic carbon implants, either for trapeziometacarpal and metacarpophalangeal joints. In particular, the silicone spacer seems to be very effective for trapeziometacarpal osteoarthrosis, while the pyrolitic carbon total joint prosthesis produces excellent outcomes if used for metacarpophalangeal replacement. Major complications, such as persistent pain and implant loosening, have still a variable rate of occurrence. AREAS OF CONTROVERSY Heterogeneity in the methodology of the assessments in the studies reviewed and the implants and techniques involved makes it difficult to carry out a complete and effective comparative analysis of the data collected. GROWING POINTS Larger cohorts treated with the same implant should be investigated in better designed trials, to draw more clinically relevant conclusions from the evidences presented. Better methodology is also a goal to achieve, since the average Coleman Methodology Score measured for the articles included was 54.9 out of 100. RESEARCH More and better designed studies are needed to produce clear guidelines to define the better implant in terms of clinical outcomes, function and complications for trapeziometacarpal and metacarpophalangeal joints.
Collapse
Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Tecame
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gugliemo Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Stefano D'Adamio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London E1 4DG, UK Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|