Metacarpophalangeal Joint Replacement Research Articles

Цифровое моделирование критических состояний эндопротезирования пястно‑фалангового сустава

Introduction The current status of small joint arthroplasty, the metacarpophalangeal joint replacement, in particular, dictates the need for development and research of new implant designs and materials for their manufacture. The vector of development of anatomically adapted implants has become established, and full preclinical study is required to obtain the best functional results from the use of new medical devices. The objective was to analyze digital models of critical conditions of metacarpophalangeal joint replacement using mechanical and clinical data. Material and methods A two‑component all-ceramic, anatomically adapted endoprosthesis of the metacarpophalangeal joint was developed between 2017 and 2021. A digital model of the metacarpophalangeal joint endoprosthesis was constructed using 3D modeling technology. Critical conditions of the digital model imitating the main stereotypes of movements were explored with the finite element method; objective technical results obtained and interpreted in a clinical language. Results Loads over 20 kg should be avoided with movements up to 60° in the early postoperative period. The load must not exceed 10 kg for motion ranging between 60° and 90°. The endoprosthesis allowed for a functional range of motion of 30-60° after MCP joint replacement without significant risks of complications. Discussion The study has demonstrated the importance of objectifying clinical results to minimize the risk of complications in a clinical scenario. Conclusion The technology based on a digital model of the metacarpophalangeal joint constructed to calculate critical conditions using the Ansys software facilitated prediction of most common complications of MCP arthroplasty and preceded further multicentric clinical trials.

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.

A biomechanical study of the effects of simulated ulnar deviation on silicone finger joint implant failure.

III.

Nora's lesion of index finger metacarpal treated by wide excision with autologous fibular grafting and metacarpo-phalangeal joint replacement

Background: Bizarre paroxysmal osteochondromatous proliferation (BPOP), also called Nora’s lesion, is a rare lesion usually involving the bones of hand. Very few cases of BPOP affecting the metacarpals are reported in literature. There is a lack of consensus on its treatment given the rare occurrence of the disease. We present a new method of treatment in BPOP involving metacarpals of the hand. It includes partial excision of metacarpal and reconstruction with fibular grafting and metacarpophalangeal (MCP) joint replacement. Case presentation: We describe a case BPOP involving the index finger metacarpal with extension upto the MCP joint. It was treated by wide excision of the lesion along with the MCP joint leaving a large defect which was reconstructed with autologous non-vascular fibular grafting and MCP joint replacement. At a follow up of one year, there was no evidence of recurrence. The patient was able to write and pinch with good functional outcome. Conclusions: BPOP is a destructive lesion which predominantly affects small bones of the hand and is known for its recurrence after local excision. Wide excision and reconstruction with non-vascularised fibular autograft along with MCP joint replacement gives good functional results. Hence this modality of treatment could be considered in dealing with the cases of BPOP especially involving the small bones of hand.

Pyrocarbon metacarpophalangeal joint replacement in primary osteoarthritis

The purpose of this retrospective cohort study was to evaluate the outcomes of 18 primary pyrocarbon metacarpophalangeal joint replacements in 10 patients, performed for primary osteoarthritis. The mean age at operation was 66 years and mean follow-up was 58.6 months. The arc of motion improved from a mean of 30° to 40° and the mean QuickDASH score improved from 35 to 17. All except one patient were satisfied with their outcomes. Radiographically, there has been no evidence of dislocation or overt loosening, although there has been subsidence of some components up to 5 mm. One index finger implant was revised to a silastic implant for perceived alteration of precision pinch. Other complications included one intra-operative fracture that united and an asymptomatic stem fracture of one proximal phalangeal component. We continue to use the implant and aim to review our experience in a further 5 years.

METALLOSIS OF A SILASTIC METACARPOPHALANGEAL JOINT ARTHROPLASTY — A CASE REPORT

Metallosis is a well-documented phenomenon in hip and knee arthroplasty from metal on metal bearing joint replacements. However, few cases of metallosis of metacarpophalangeal joint replacements have been reported. We present the case of a 49-year-old lady with rheumatoid arthritis who had previously undergone MCP joint replacements over 20 years ago. The decision was taken to revise her middle MCP joint after she developed pain and ulnar drift. At revision, the joint exhibited severe metallosis presumably arising from the grommet component of the replacement. This required considerable debridement and removal of the components and revision to a new upsized implant without grommets. It is of note that there were no external signs of metallosis with full flexion of the finger and a good roll up.

Three- to Six-Year Results of Metacarpophalangeal Joints Arthroplasty in Psoriatic Arthritis

Patients with psoriatic arthritis often need the replacement of the hand joints owing to the high prevalence of hand joints involvement and their often severe destruction and/or function loss. The long-term results of silicone arthroplasty of metacarpophalangeal joints in psoriatic patients are almost unreported in the scientific literature. We analyzed 3- to 6-year results of 14 metacarpophalangeal joint replacements with silicone implants that we performed in nine psoriatic patients. The metacarpophalangeal joints arthroplasty in all the patients led to the significant short-term and long-term increase of range of motions and decrease of pain. However, two complications occurred. The choice of the implant, the possibility, causes, and significance of the complications are justified. Metacarpophalangeal joints silicone arthroplasty in psoriatic arthritis during skin manifestations remission period is an effective and relatively safe method of finger joints contractures and deformities treatment.

Wound healing with medications for rheumatoid arthritis in hand surgery.

Introduction. Medications used to treat rheumatoid arthritis, such as corticosteroids, disease-modifying agents (DMARDs), and injectable biological agents (anti-TNFα), may have widespread effects on wound healing. In hand surgery, it is important to balance the risks of poor wound healing from continuing a medication against the risks of a flare of rheumatoid arthritis if a drug is temporarily discontinued. Materials and Methods. A United Kingdom (UK) group of 28 patients had metacarpophalangeal joint replacement surgery in 35 hands (140 wounds). All medication for rheumatoid arthritis was continued perioperatively, except for the injectable biological agents. Results. There were no instances of wound dehiscence or deep infection and only one episode of minor superficial infection. Conclusions. We conclude that provided care is taken to identify and treat any problems promptly, it is appropriate to continue most antirheumatoid medications in the perioperative period during hand surgery to reduce the risk of destabilising the patients' overall rheumatoid disease control.

Surface replacement arthroplasty of the proximal interphalangeal and metacarpophalangeal joints: The current state

ABSTRACTSurface replacement arthroplasty for proximal interphalangeal joint and metacarpophalangeal joints are becoming popular. Low profile, anatomically designed implants limit the amount of bone removed but need preservation of the collateral ligaments. Pyrocarbon and cobalt-chrome stemmed unconstrained implants on ultra-high molecular weight polyethylene are the two commonly available bearing surfaces. The indications for small joint arthroplasty are degenerative, post-traumatic or rheumatoid arthritis. Early results are encouraging, primarily in patient satisfaction and pain relief, but are based on low numbers. The main concerns are progressive loss of range due to implant settling, dislocation, squeaking and poor osteo-integration with the appearance of a radiolucent line at the bone–implant interface. Our experience suggests that metacarpophalangeal joint replacements consistently give good results.

Surface replacement arthroplasty of the proximal interphalangeal and metacarpophalangeal joints: The current state

Surface replacement arthroplasty for proximal interphalangeal joint and metacarpophalangeal joints are becoming popular. Low profile, anatomically designed implants limit the amount of bone removed but need preservation of the collateral ligaments. Pyrocarbon and cobalt-chrome stemmed unconstrained implants on ultra-high molecular weight polyethylene are the two commonly available bearing surfaces. The indications for small joint arthroplasty are degenerative, post-traumatic or rheumatoid arthritis. Early results are encouraging, primarily in patient satisfaction and pain relief, but are based on low numbers. The main concerns are progressive loss of range due to implant settling, dislocation, squeaking and poor osteo-integration with the appearance of a radiolucent line at the bone–implant interface. Our experience suggests that metacarpophalangeal joint replacements consistently give good results.

Wear testing of a DJOA finger prosthesis in vitro

Although the market for replacement of diseased metacarpophalangeal (MCP) joints is dominated by single-piece silicone prostheses, several two-piece designs have been implanted. One such is the Digital Joint Operative Arthroplasty (DJOA) which consists of a part-spherical stainless steel metacarpal component which articulates within a matching concave phalangeal component made of ultra high molecular weight polyethylene (UHMWPE). A DJOA MCP prosthesis was tested using a clinically-validated finger simulator while a second DJOA prosthesis acted as a statically-loaded soak-control. Testing ran to 7.1 million cycles of flexion-extension. It was found that the UHMWPE components, both test and control, gained in weight by a similar amount. Therefore apparently there was no wear of the test components. However, the initial and final surface finish values of the test stainless steel metacarpal head were relatively high. Calculations based on this roughness data, plus recent dynamically-loaded soak data, may explain the apparent lack of wear.

Survivorship of the Neuflex Silicone Implant in MCP Joint Replacement

The Neuflex silicone metacarpophalangeal (MCP) joint replacement has previously been shown to provide improved movement, particularly flexion, when compared with the Swanson implant. In this study, we reviewed the outcome of 237 Neuflex implants in 66 patients with a follow-up of up to 7 years. Kaplan-Meier analysis using revision as the end stage revealed survival at 7 years to be 88%. If however an implant fracture, as seen radiographically, is taken as the end point, the survivorship drops to 68% at 7 years. These figures are comparable with a similar analysis for the Swanson implant. We conclude that the improved range of motion of the Neuflex implant demonstrated previously does not result in either a higher or a lower revision or implant fracture rate when compared with the Swanson implant.

A rare complication of a metacarpophalangeal joint replacement in a rheumatoid hand: a case report

Metacarpophalangeal joint replacement is one of the most common surgery performed for rheumatoid hand deformities. The systemic and progressive nature of rheumatoid arthritis and other inflammatory arthritis make isolated assessment and treatment of metacarpophalangeal joint joints challenging.Extensive joint involvement and systemic nature of the illness has an impact in the prognosis of the illness. The long term outcome of the surgical procedure depends on how best the illness is controlled. Technical aspects of the surgery in patients with rheumatoid arthritis can be widely variable and can make implant arthroplasty challenging. We present a case report of an unusual presentation of a rare complication following metacarpophalangeal joint replacement performed 17 years ago.

Treatment of rheumatoid arthritis with metacarpophalangeal joint replacement

Objective To investigate the technique and clinical outcome of treating rheumatoid arthritis with metacarpophalangeal joint replacement. Methods From January 2002 to January 2007, 13 digits in 8 patients with rheumatoid arthritis were treated by metacarpophalangeal joint replacement using Swenson prosthesis. Joint range of motion and postoperative pain in all eases were measured to evaluate the treatment out. Results Primary wound healing was achieved in all cases. The followed up time was from 9 months to 24 months with an average of 15.8 months. According to assessment standard described by Li, treatment outcome was graded as excellent in 9 fingers and good in 4 fingers. Conclusion Metacarpophalangeal joint replacement is an effective method to treat rheumatoid arthritis. Key words: Arthritis, rheumatiod; Metacarpophalangeal joint; Arthroplasty, replacement

Soft layered concept in the design of metacarpophalangeal joint replacement implants

The metacarpophalangeal (MCP) joint is crucial for hand function, but the joints are frequently affected by arthritis, leading to pain and disability. Joint replacement implants are used to replace the diseased MCP joint. This paper presents an investigation of applying the soft layered concept in the design of a new MCP joint replacement implant. Analytical methods were used to investigate the minimum film thickness for a novel MCP joint with a soft layer. The effect of load, entraining velocity, radial clearance, radius of the metacarpal head, elastic modulus and thickness of the soft layer were investigated. The soft layered joints show an enhanced predicted film thickness and some evidence of fluid film lubrication that should help to reduce wear rates. It may be beneficial for future MCP joint implant designs to utilise the soft layered joint concept.

BIOMECHANICS OF THE NORMAL AND DISEASED METACARPOPHALANGEAL JOINT: IMPLICATIONS ON THE DESIGN OF JOINT REPLACEMENT IMPLANTS

The metacarpophalangeal (MCP) joint is crucial for hand function, but is frequently affected by arthritis, leading to pain and disability. This paper reviews the biomechanics of the normal and diseased joint in order to help consider the design of improved MCP joint replacement implants. The normal MCP joint enables a large range of motion in flexion/extension and abduction/adduction as well as a few degrees of rotation. A normal joint typically allows 90° flexion, with a grip strength of up to 672 N. The diseased joint has a reduced range of motion (typically 30° flexion) and reduced hand strength compared to the normal joint. Current MCP joint replacement implants generally try to recreate the range of motion of the normal joint; however, many designs are prone to fracture, as they are unable to withstand the conditions of the diseased joint. It may be beneficial for future implant designs to provide just a functional range of motion. Future designs of MCP joint replacement implants need to be more durable and last longer. Careful consideration of the diseased joint, rather than the normal joint, may help to better define the requirements for such implants.

Silastic metacarpophalangeal joint arthroplasty

Of all the joints of the hand arthroplasty of the metacarpophalangeal joint of the fingers has been most widely undertaken and probably the most successful procedure. The success is in no small matter due to the success of silicone hinged implants at this site, combined with this joints frequent involvement in patients with rheumatoid arthritis. As a consequence the replacement of this joint in this group of patients has become the operation of choice, with long term benefits reported over many years. In 1968 Swanson and Niebauer reported the use of a silicone rubber spacer metacarpophalangeal joint replacement (Fig. 1). At that time they reported good to excellent short term results, which have ultimately been reproduced throughout the world. From that time there have been a number of further developments of this type of implant with an improvement in the materials used, and also the design. The use of this type of silicone-based implant has been so successful that it is now hard to envisage that any hand surgery unit does not use this type of implant on a routine basis. As stated previously the indication par excellence for arthroplasty of the metacarpophalangeal joint is inflammatory arthritis, particularly rheumatoid arthritis and it is in this situation that the hinged silastic implant has been proved to be ideal. For other indications however, particularly trauma or osteoarthritis, silastic has been less successful, the principal reason being that in the otherwise normal hand the forces applied to the implant quite quickly result in failure of the silastic. As a consequence of this newer two-part prosthesis has been developed that is often made of titanium or cobalt chrome with high density polyethylene, the designs often mimicking normal anatomy. More recently a newer material, pyro-carbon, has become available. With these new implants, however, have come changes in surgical technique. For the silastic implants essentially the procedure is one of an excision arthroplasty with the silastic acting as an internal splint, allowing the soft tissues to rebalance. Plainly this is not the case with the two-part implants and as such greater care has to be taken with regard to bone resection and realignment as instability can be a significant problem.

12.5 IS CROSSED INTRINSIC TRANSFER EFFECTIVE IN PREVENTING THE RECURRENCE OF ULNAR DEVIATION FOLLOWING METACARPOPHALANGEAL JOINT REPLACEMENTS?

Seventy three hands in patients with rheumatoid arthritis undergoing primary index to small finger metacarpophalangeal joint replacements were studied retrospectively. In twenty eight hands a crossed intrinsic transfer was performed and in forty five hands it was not. A similar splintage and rehabilitation programme was followed in each group. The two treatment groups had similar preoperative ulnar drift (crossed intrinsic transfer group mean 27°, comparative group 29°). At a mean follow up of 50 months the crossed intrinsic transfer group had statistically less ulnar drift (crossed intrinsic transfer group mean 6°, comparative group mean 14°, P=0.01). There were no other significant differences at follow up.

Survival and complications are similar after Swanson and Sutter implant replacement of metacarpophalangeal joints in patients with rheumatoid arthritis

We compared the survival, fracture, and deformation rates of Swanson and Sutter implants in a prospective series of 53 patients with rheumatoid arthritis (RA). Fifty-eight hands were operated on with 215 silastic implants. The Swanson group comprised 25 hands and 89 implants, and the Sutter group 33 and 126, respectively. Follow up was 58 (37-80) months. During a period of 48 months the survival of Swanson and Sutter prostheses did not differ significantly: 92% (95% CI 84% to 96%) and 97% (95% CI 92% to 99%), respectively. The fracture rate was high in both groups: 26 (34%) in the Swanson and 25 (26%) in the Sutter group. There was no significant difference between the groups in definite fracture rates of implants. The Sutter prosthesis appears to be at least as durable an implant in rheumatoid patients' metacarpophalangeal arthroplasty as the Swanson.

Metacarpophalangeal Joint Silicone Implant Arthroplasty

Silastic metacarpophalangeal joint replacement has been used successfully to treat patients with inflammatory arthritis, particularly rheumatoid arthritis of the hand, for many years. Initially, patients can expect satisfactory relief of pain, improved alignment, movement between 30° to 60° of active flexion, and, as a consequence, improved function. The implants themselves can survive in situ for many years with a published overall survival rate of greater than 60% at 15 years or more. There are, however, a number of complications, these complications and their management are discussed further.