Metacarpophalangeal joint mechanics after 3 different silicone arthroplasties

Abstract

This study was performed to compare metacarpophalangeal (MCP) joint mechanics after arthroplasty with 3 currently available silicone implants and to determine how postarthroplasty mechanics compares with the mechanics of the intact joint. Planar 2-dimensional kinematic analysis was performed using digitized radiographs on 10 isolated fingers harvested from 5 fresh-frozen human cadavers. Radiopaque markers were affixed to the metacarpals and proximal phalanges, sewn to the flexor and extensor tendons, and placed into the stems and hinges of the implants. Each finger was tested intact, and after MCP joint replacement with 3 implants (Swanson [Wright Medical, Memphis, TN], Avanta [Avanta Orthopaedics, San Diego, CA], and NeuFlex [DePuy Orthopaedics, Warsaw, IN]). The fingers were secured to the test fixture and the flexor digitorum profundus flexor and extensor tendons were loaded with physiologic weights. Lateral radiographs were taken at approximately 10 degrees intervals and were digitized on a high-resolution scanner. Instantaneous center of rotation (ICR), tendon excursion, and tendon moment arm were calculated. Statistical analysis was performed using repeated measures one-way analysis of variance and Dunnett post tests. The ICRs of the intact and implanted MCPs did not follow a smooth path. The variability of the ICRs of the intact MCP joints was 2.1 +/- 0.8 mm. The variations in the Avanta and DePuy implants were similar (3.1 +/- 1.0 mm and 3.5 +/- 1.5 mm, respectively), whereas the Swanson implant was higher (4.9 +/- 1.7 mm). Implant pistoning was most pronounced with the Swanson implant, which moved 2.40 +/- 0.97 mm over the full range of motion. The Avanta and DePuy implants pistoned significantly less than the Swanson implant (1.05 +/- 0.45 mm and 0.69 +/- 0.31 mm, respectively). Flexor tendon excursion was greater for the intact joint when compared with all 3 implants while extensor tendon excursion was similar for all. Flexor tendon moment arm was similar for the intact joint and the Avanta and NeuFlex implants whereas the Swanson implant was reduced significantly; extensor tendon moment arms were similar for all. The ICR of the NeuFlex implant most closely matched that of the intact MCP joint. The Swanson implant had greater pistoning and dorsal-volar translation when compared with the intact joint and the Avanta and NeuFlex implants. The block-hinge type design of the Avanta and NeuFlex implants improved tendon moment arm overall when compared with the Swanson, likely imparting greater functional ability for finger motion. Overall the NeuFlex implant most closely matched the ICR, tendon excursion, and moment arm when compared with the intact native MCP joint.