Motion after metacarpophalangeal joint reconstruction in rheumatoid disease

Abstract

The outcome of reconstruction of the rheumatoid metacarpophalangeal joint may deteriorate with time, especially with respect to active motion. This study assesses active finger motion after crossed intrinsic transfer and Swanson implant arthroplasty at increasing durations of follow-up to determine the effect of time. In a total of 58 patients, 21 hands had the crossed intrinsic transfer operation and 49 had the arthroplasty. Follow-up time averaged 6 years for the crossed intrinsic transfers and 21 months for the arthroplasties. Measurements of metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joint active motion at each follow-up interval were analyzed by the univariate repeated measures analysis of variance method. After crossed intrinsic transfer the overall average active range of motion decreased significantly (18 degrees) at the metacarpophalangeal joint. Proximal interphalangeal and distal interphalangeal average range of motion significantly increased during the first 5 years as a result of increases in flexion. After implant arthroplasty, the overall average metacarpophalangeal range of motion was 42 degrees, which represented an increase of 8 degrees over the preoperative value. Motion analysis at the different follow-up intervals showed that the metacarpophalangeal average range of motion significantly increased during the first 2 years and then gradually declined through the duration of follow-up. Active proximal interphalangeal flexion was also significantly increased during the first 2 postoperative years. The effects of metacarpophalangeal joint reconstruction on active finger joint motion are related to the duration of postoperative follow-up; this concept should be considered when one is planning metacarpophalangeal joint reconstruction in rheumatoid patients.