Metacarpophalangeal Arthroplasty Research Articles

Long-Term Implant Fracture Rates Following Silicone Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis

The primary objective of this study was to compare the long-term survival rates of silicone metacarpophalangeal (MCP) arthroplasties between two major implants in patients with rheumatoid arthritis, using implant fracture as an end point. We also evaluated the difference in postoperative function between patients with fractured and intact implants as a secondary objective. A retrospective cohort study was conducted on 372 fingers of 133 hands that underwent silicone MCP arthroplasty between January 2000 and June 2019 (mean follow-up, 7.6 years). The survival rates of Swanson-type and Sutter-type implants were compared, using implant fracture as the end point after a radiographic evaluation. Clinical measures and upper limb functional assessments using the Disabilities of the Arm, Shoulder, and Hand (DASH) score were performed in the nested cohort. The 10.6-year survival rates for implant fracture of Swanson- and Sutter-type implants were 86.2% and 9.4%, respectively, with significantly higher survival noted for Swanson-type implants. The Sutter-type implant showed increased susceptibility to fracture in all four fingers compared to the Swanson-type implant. Implant fractures were primarily observed at the stem-hinge junction. There were no significant differences in upper limb function between the fractured and intact implant groups. Sutter-type implants were found to be more prone to fracture compared with Swanson-type implants. However, implant fractures did not significantly affect upper limb function. Prognosis IV.

Primary Arthrodesis of Non-thumb Metacarpophalangeal Joints of the Hand: Clinical and Patient-Reported Outcomes.

Metacarpophalangeal (MCP) joint arthritis is common secondary to a variety of inflammatory, degenerative, and traumatic causes. Although MCP arthroplasty is more common for the second to fifth digits, primary arthrodesis can be used for high-demand patients with arthritis or unsalvageable fractures of the MCP joint. There has been limited recent studies on the outcomes of these patients. A retrospective review of 38 fingers in 27 patients with primary arthrodesis from 1990 to 2020 was conducted. The major outcomes were complications, reoperations, radiographic union, and time to union. Patient-reported outcomes including the Michigan Hand Outcomes Questionnaire and a questionnaire specific to the operative MCP joint were collected. Rate of radiographic union was 84% including revisions. The average time to union was 3.6 months. Rates of complications, reoperation, and amputation were 26%, 16%, and 7%, respectively. Arthrodesis as part of emergent trauma reconstruction was significantly more likely to result in reoperation (50% vs 7%) and complication (63% vs 17%) than chronic arthritis. Patient-reported outcomes were fair to good with improvement in pain (79%), function (66%), and appearance (40%). Sixty-six percent (66%) of patients were satisfied with their surgery, and 73% would repeat the surgery. Arthrodesis for unsalvageable MCP fractures was associated with higher rates of reoperation and complication than inflammatory or degenerative arthritis. Excluding emergent trauma, MCP fusion was reliable with a reoperation rate of 7% and a modest complication rate of 17%. Patients rated reasonable levels of satisfaction and willingness to repeat the procedure despite complications.

The silicone metacarpophalangeal joint arthroplasty: An in-vitro analysis

BackgroundSilicone is still the gold standard implant in metacarpophalangeal arthroplasty. Whereas the clinical results are acceptable, in follow-ups with >10 years, high rates of implant fracture are common, and 5 to 7% of implants required revision. This work's purpose is to analyse the hypothesis that the joint flexion amplitude has a relevant effect on bone strain level, implant stress and bone-implant micromotion, which can reflect an increase in the risk of bone resorption/fatigue failure, implant fracture and osteolysis. MethodsTo experimentally predict the cortical loading behaviour, composite metacarpals and proximal phalanges were used in intact and implanted states. A finite element model was developed to evaluate the structural behaviour of cancellous bone and implant. This model was validated by comparing cortical strain and load–displacement curve with experimental measurements. FindingsBone strain changes between the intact and the implanted states showed a load transfer effect from the cortical to the cancellous bone that increases significantly with the flexion's amplitude rise. The peak implant stress occurred in the flexion amplitudes further away from the implant neutral angle. The highest implant pistoning motion and the highest phalanx cancellous-bone strain occurred simultaneously at the maximum flexion amplitude. InterpretationLimiting joint flexion range will be helpful to reduce the strain-shielding effect on cortical bone, minimizing the overload effect on cancellous bone and decreasing the stress levels and the pistoning motion on the implant, ultimately contributing to the longevity of silicone arthroplasty.

Managing Difficult Problems in Small Joint Arthroplasty: Challenges, Complications, and Revisions.

Small joint arthroplasty of the hand has been an established means of joint preservation and pain relief for over a half a century. Despite this, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint arthroplasty has not achieved the long-term success seen with hip and knee arthroplasty. Problems following MCP, PIP, and carpometacarpal (CMC) joint arthroplasty can include intraoperative fracture, postoperative dislocation, recurrent pain, limitation of motion, and instability. The hand surgeon needs to be prepared for these problems and their management. This article addresses the management of the most common complications seen following MCP, PIP, and CMC arthroplasty.

Metacarpophalangeal Joint Pyrocarbon Arthroplasty for Osteoarthritis: An Analysis of 44 Arthroplasties

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. 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. 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. 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. Therapeutic IV.

Эндопротезирование пястно-фалангового сустава (обзор литературы)

Introduction Diseases and injuries that affect the small joints of the hand, the metacarpophalangeal, in particular, lead to a limitated hand function and a reduced quality of life. The high functional demands of the hand impose strict restoration requirements and the development of the new and improvement of the existing surgical treatments of hand joints remains a serious challenge for the medical community. Arthroplasty of the metacarpophalangeal joint is widely used and can help restore function to hand. Despite the long history of arthroplasty procedures there is controversy concerning functional results. Objective Review foreign and Russian literature on metacarpophalangeal joint replacement and analyze the current state of the problem. Material and methods Foreign and Russian scientific publications on the treatment of metacarpophalangeal diseases and injuries were reviewed. Online searching for the articles published in Russian and English in the last five years was performed with the help of GoogleScholar, PubMed, eLIBRARY, PubMedCentral using the keywords "arthroplasty of the metacarpophalangeal joint", "osteoarthritis of the metacarpophalangeal joint", "finger joint replacement". Results and discussion Today, a wide range of total hip prosthesis designs, differing in geometric configurations and features is available with the current trend towards adaptation of the soft tissues to the structural modifications. Major indications for the use of different types of arthroplasty have been identified. Specific design features of implants can show higher failure rates and postoperative complications. Conclusion Arthroplasty is the best surgical treatment option for diseases and injuries of the metacarpophalangeal joint and improved construction solutions and materials for metacarpophalangeal arthroplasty are essential for better outcomes.

Shapes and Sizes of Common Silicone Metacarpophalangeal Arthroplasties: Clinical Implications.

Background: Silastic metacarpophalangeal joint (MCPJ) arthroplasty is a recognised treatment for painful finger arthritis. There are two commonly used, albeit different, designs; the Swanson and the NeuFlex©. Which design is optimal is unclear. The purpose of this study was to evaluate the radiological differences relative to the bones following implantation. Methods: We examined the radiological features of these implants up to 1 year of follow-up. We reviewed the postoperative radiographs of 42 patients with 113 MCPJ arthroplasties and assessed the implant body anatomical 'fit' relative to the widths of the cut metacarpals and proximal phalanges and resection lengths of the metacarpal heads. We also looked for potential axial implant rotation. Results: The Swanson implants were consistently and statistically significantly wider than the NeuFlex© implants and almost always overhung the margins of the native MCPJ. Four of 33 (12%) of the Swanson and 1 of 80 NeuFlex© implants had rotated axially, the difference was statistically significant. One NeuFlex© implant had fractured at its hinge. Conclusions: The appreciable difference in the positions of the implant bodies relative to the bones may be important. The overhang of the Swanson implants may confer some stability to the arthroplasty helping to resist lateral deviation forces, but concomitant ligament reconstruction may increase the risk of implant rotation which is likely to reduce the postoperative ranges of motion. Axial silastic implant rotation has not previously been reported. It may influence joint biomechanics; future implant designs should consider the risks of implant rotation. Level of Evidence: Level IV (Therapeutic).

Outcomes of Pyrocarbon Arthroplasty in Metacarpophalangeal Joints Affected by Rheumatoid Arthritis.

Rheumatoid arthritis (RA) affecting the metacarpophalangeal (MCP) joint may warrant arthroplasty. The purpose of this study was to investigate implant survivorship, complications, radiographic outcomes, and clinical outcomes in patients undergoing MCP arthroplasty with a pyrocarbon implant to treat RA. In all, 124 MCP joint pyrocarbon arthroplasties in 40 patients performed to treat RA were reviewed. Operations were at the index (n = 43, 35%), middle (n = 33, 27%), ring (n = 27, 22%), and small (n = 21, 17%) fingers from 1998 to 2009 in 105 (85%) female and 19 (15%) male joints with a mean age of 54 ± 11 years. Mean postoperative follow-up was 6 ± 3 years. All patients achieved at least 2 years of follow-up. Rates of implant survivorship at 1, 2, 5, and 10 years were 98%, 98%, 90%, and 81%, respectively. Fifteen percent (n = 18) of arthroplasties underwent revision at a mean 5 ± 3 years postoperatively. The overall reoperation rate was 29% (n = 36). Rates of survival from reoperation at 1, 2, 5, and 10 years were 85%, 84%, 76%, and 68%, respectively. Complications occurred in 32% (n = 40). Pain ratings improved postoperatively (P < .01). Arc of motion improved from 37 ± 21 to 43 ± 19 (P = .03). Both appositional and oppositional strength improved after surgery; however, there was no improvement in grip strength (P < .01). Metacarpophalangeal arthroplasty with a pyrocarbon implant demonstrated reliable improvement in pain and arc of motion in patients with RA. Complication and overall reoperation rates were high, while 1 in 10 undergo revision within 5 years postoperatively.

Bilateral Isolated Third Metacarpophalageal Arthritis at Long-Term Follow Up After Bilateral Wrist Fusion

Total wrist fusion is an established surgical option for the management of severe wrist arthritis. Long-term sequelae of wrist fusion are numerous and incompletely understood. The following case documents a patient who developed third metacarpophalangeal (MCP) joint arthritis following radiocarpal wrist fusion with a plate and screw construct from the radius to the third metacarpal. An MCP arthroplasty was subsequently performed and outcomes reported. This case report outlines the need for further study of the force transmission through and motion of the MCP joint following a radiocarpal wrist arthrodesis.

Emergency metacarpophalangeal arthroplasty with bone grafting for traumatic joint destruction: a report on two cases

Traumatic destruction of the metacarpophalangeal joints with bone defect is a technical challenge for surgeons when maintaining joint mobility is a priority for the patient. An emergency metacarpophalangeal arthroplasty with bone graft has been described in the literature for dorsal defects in the proximal phalanx. We have adapted this technique to allow us to perform this arthroplasty with bone graft in all defects of the proximal phalanx.

Determinants of long-term satisfaction after silicone MCP arthroplasty in patients with inflammatory diseases

The aim was to identify determinants of satisfaction in patients with inflammatory diseases who underwent hand reconstruction using silicone metacarpophalangeal (MCP) arthroplasty. We hypothesized that patients taking biologic drugs would be more satisfied with the outcome. Patients who underwent silicone arthroplasty and had a minimum follow-up of 1 year were included. Patients rated their satisfaction with the treatment result and hand appearance on a 5-point Likert scale with a score of 5 indicating “very satisfied” and 1 indicating “very dissatisfied” and completed the brief Michigan Hand Outcomes questionnaire (MHQ). MCP range of motion (ROM), ulnar drift and grip strength were measured. Ordered logistic regression modelling and the Mann–Whitney U test were used. Forty-one patients with 118 operated fingers were available for follow-up at an average of 5.6 years after surgery. Patients were satisfied with the overall treatment result (score 4.4; SD 0.8), but only somewhat satisfied (score 3.3; SD 1.5) with their hand's appearance. Total MCP ROM was 61° (SD 21) with an ulnar deviation of 10° (SD 14). Appearance and ulnar deviation were significant determinants of satisfaction (R2=0.35). There was no difference in outcomes between patients using biologics and those who were not. Our hypothesis that patients taking biologics are more satisfied after surgery could not be proven. Hand appearance and ulnar drift are the most important determinants of satisfaction after reconstruction of MCP deformity.

Trends in Proximal Interphalangeal and Metacarpophalangeal Joint Arthroplasty Utilization Using Statewide Databases.

Background: Arthritis can have profound debilitating effects on the hand secondary to finger deformities and pain. Arthroplasty of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) can be performed to reduce pain while maintaining joint range of motion. Methods: We used outpatient surgery registries from the states of California and Florida to assess the trends of arthroplasty across several recent years and to determine if the outcomes differ based on disease etiology. Results: We found that there has been a steady decline in number of MCP arthroplasty procedures performed annually between 2005 and 2011 while PIP arthroplasty procedures peaked in 2007 and have since also declined. There was an overall complication rate of 2.4% and no difference in cardiac, respiratory, deep venous thrombosis and infection between patients with osteoarthritis and other arthritic etiologies. However, the risk of device failure in patients with rheumatoid arthritis is found to be significantly higher than for patients with osteoarthritis (p < 0.01). Conclusions: PIP and MCP arthroplasty are safe procedures with an overall low complication rate. The increased risk of device related complications observed in patients with rheumatoid arthritis can be used to appropriately counsel this patient population regarding post-operative expectations and prognosis.

Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint.

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.

Revision Metacarpophalangeal Arthroplasty: A Longitudinal Study of 128 Cases

The objective was to examine outcomes associated with a large cohort of revision metacarpophalangeal (MCP) arthroplasties. 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. 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. 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 IV.

Factors Associated With Reoperation After Silicone Metacarpophalangeal Joint Arthroplasty in Patients With Inflammatory Arthritis.

Background: Silicone metacarpophalangeal (MCP) joint arthroplasty has a high revision rate. It has been suggested that the preoperative degree of ulnar drift and radial wrist deviation influences the durability of MCP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone MCP arthroplasty. Materials and Methods: We retrospectively evaluated all adult patients who underwent MCP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory arthritis. After manual chart review, we included 73 patients who underwent 252 arthroplasties. Fingers treated included 66 index, 67 long, 60 ring, and 59 small fingers. Results: The overall reoperation rate was 9.1% (N = 23). Indications for reoperation were implant breakage (n = 11), instability (n = 4), soft tissue complications (n = 4), infections (n = 3), and stiffness (n = 1). There was a trend that patients who underwent single-digit arthroplasty had higher rates of revision (19% vs 3.5%, P = .067). Radiographic follow-up demonstrated joint incongruency in 50% of cases, bone erosion in 58% of cases, and implant breakage in 19% of cases. There was a trend toward higher rates of revision in patients without preoperative MCP joint subluxation (19% vs 6.7%, P = .065) The 1-, 5-, and 10-year implant survival rates were 96%, 92%, and 70%, respectively. Revision surgery occurred at <14 months in 15 patients (65%) and after 5 years in 8 (35%) patients. Conclusions: Revision surgery after silicone MCP arthroplasty appears to be bimodal. Patients with greater hand function preoperatively may be at higher risk of revision surgery.

Hand therapy following post-traumatic metacarpophalangeal joint arthroplasty: A case report

The purpose of this case report is to contribute to the literature on the physiotherapy assessment and treatment methods following metacarpophalangeal (MCP) joint arthroplasty and to present the results of our treatment program. The patient was a 27-year-old male military staff with a left hand traumatic injury. One year after injury, MCP joint was replaced with a pyrocarbon implant. Hand therapy was planned as four consecutive stages. The first phase focused on early interventions and patient education. After 4 weeks, active joint movements were emphasized. Additional emphasis was placed on strengthening exercises and prevention of the complications in the later stages. In the late-term rehabilitation program after 12th week, return to work and daily life was targeted. The patient was assessed at the 4th, 8th, 12th and 16th weeks after the surgery. The results of the range of motion, grip and pinch strength, functional test and disability level all improved with the treatment program. Initial signs of potential complications were also noted and precaution was taken. Patient-tailored hand therapy program provided significant functional improvements after post-traumatic MCP arthroplasty. Besides, signs of potential complications were recognized through early interventions and regular assessments and any deformity was prevented.

Long-term outcomes of silicone metacarpophalangeal arthroplasty: a longitudinal analysis of 325 cases.

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 7.2years (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.

Hand and wrist joint procedures in sclerodermic patients – a systematic review

Hand reconstructive surgery in systemic sclerosis has long time been considered a taboo due to the frequent global stiffness and menaced wound healing associated with digital ischemia and skin tightness. We assumed that joint procedures to sclerodermic hands or wrists have not a higher rate of infection, wound healing problem or non-union in comparison to non-sclerodermic population. We systematically reviewed the literature assessing these complications after performing joint reconstruction in hands and wrists of sclerodermic patients. Studies were identified through systematic review of the available literature in the Pubmed Medline, Cochrane Central Register of Controlled Trials, Embase, Web of Science database up to May 3rd, 2017. Database was searched using a set of search terms, which described systemic sclerosis, bone and joint surgery, and hand or wrist surgery. Only studies including joint procedures in hands or wrists of sclerodermic patients that were related to the functional outcomes and morbidity after surgery were selected. Reviews were excluded. Studies relevant to soft tissue reconstruction in sclerodermic hands or wrists, such as digital sympathectomy, autologous adipose-derived stromal vascular fraction, vascular reconstruction or management of finger ulcers were also excluded. Results A total of 265 unique articles were identified in PubMed. Thirty-eight titles selected for abstract review. Twenty-nine abstracts did not meet the inclusion criteria or did not evaluate our predefined endpoint and were excluded. Nine articles were fully read and two more articles were considered irrelevant and excluded. Seven studies were deemed eligible for our systematic review. One hundred and sixteen sclerodermic patients were found. A total of 402 joint procedures in sclerodermic hand and wrist were exported. The operations concerned metacarpophalangeal and interphalangeal arthroplasty, joint replacement or fusion, Kapandji procedures, osteotomy of the finger and removal of the hardware. A low complications rate in terms of infection or digital ischemia after surgery was mentioned to all studies. In most of the cases, wound healing was uneventful and only in some cases, it was described slow. In cases of joint fusion, bone healing was successfully achieved. The functional outcome was reliable in all the cases. The wrist and hand joint procedures in systemic sclerosis were found to be reliable and related to low morbidity in terms of infection rate, wound healing and bone union. Results from future studies will unquestionably contribute to further establishment of knowledge about the therapeutic outcome after surgery in these suboptimal conditions of the sclerodermic hand.

Silicone Metacarpophalangeal Arthroplasty for Osteoarthritis: Long-Term Results.

To demonstrate that silicone metacarpophalangeal (MCP) arthroplasty provides excellent long-term outcomes with a low complication rate in osteoarthritis patients. 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. 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. Silicone arthroplasty is effective in the treatment of primary MCP osteoarthritis. Implant survivorship is 97% (clinical) and 88% (radiographic) in long-term follow-up. Therapeutic IV.

Outcomes Following Acute Metacarpophalangeal Joint Arthroplasty Dislocation: An Analysis of 37 Cases.

There remains a paucity of information regarding the treatment outcomes of dislocation after metacarpophalangeal (MCP) joint arthroplasty. The purpose of this study was to assess the outcomes of surgical and nonsurgical treatment modalities of MCP arthroplasty dislocations. Of 816 MCP joint arthroplasties over a 14-year period, there were 37 (4%) acute MCP joint dislocations that required intervention by a health care professional. Implants involved included 28 nonconstrained implants including pyrocarbon (n= 17) and surface replacement arthroplasty (n= 11), and 9 silicone implants. The analysis included the treatment of dislocations after primary (n= 30) and revision (n= 7) MCP joint arthroplasty. Dislocation was defined as clinical and radiographic evidence of MCP joint prosthetic acute dislocation diagnosed and treated by a fellowship trained hand surgeon. Etiologies underlying the dislocations included implant fracture (n= 6), component loosening (n= 2), and soft tissue deficiency (n= 29). Of the 37 dislocations, treatments included 14 nonsurgical (closed reduction, orthosis fabrication) all of which ultimately failed. Surgically, including some of the failed prior procedures, 18 soft tissue stabilization procedures and 21 revision arthroplasties were performed, with 6 that had failed soft tissue stabilization. The soft tissue stabilization procedures had a 28% success rate in achieving a stable MCP joint. Revision arthroplasty had a 71% success rate. Subgroup analysis showed an 86% success rate for silicone revisions and a 43% success rate with nonconstrained revisions, with 80% and 36% 5-year survival free of instability, for the 2 types of implants, respectively. The treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation. Therapeutic IV.