Abstract
BackgroundThe aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints.MethodsWe evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint.ResultsThe median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8).ConclusionIn conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants.Level of evidenceIII (Therapeutic).
Highlights
The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints
We designed a comparative retrospective cohort study of patients operated with either perichondrium transplantations or two-component SR implants to the MCP or PIP joints performed at Uppsala University Hospital between 1981 and 2018
The major finding in the present study was that the long-term outcome after perichondrium transplantation at least equals the results obtained with modern SR implants
Summary
The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Articular cartilage is a highly specialized tissue with limited capacity to repair itself. Different surgical methods aiming towards cartilage repair or regeneration have been introduced, e.g. microfracturing methods, mosaicplasty, osteochondral allografting, autologous chondrocyte implantation, periosteal transplantation and perichondrial transplantation [2,3,4,5]. Reconstruction of the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints in patients with osteoarthritis or rheumatoid arthritis is challenging, especially in young individuals with a long life expectancy and high physical demands. Insertion of two-component surface replacement (SR) implants is currently a common method to reconstruct osteoarthritic finger joints in the nonrheumatoid patient. Variable results and reoperation rates as high as 58% have been reported after SR implants to the PIP join [7]
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