Silastic Arthroplasty Research Articles

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.

The Incidence of Extensor Tendon Adhesion at the Wrist During Silastic Arthroplasty for Metacarpophalangeal Joints in Patients with Rheumatoid Arthritis

The Incidence of Extensor Tendon Adhesion at the Wrist During Silastic Arthroplasty for Metacarpophalangeal Joints in Patients with Rheumatoid Arthritis

First Metatarsophalangeal Arthrodesis or Silastic Arthroplasty in the Management of End-Stage Hallux Rigidus: A Comparison of Outcomes Including Proms

Both first metatarsophalangeal arthrodesis and Swanson silastic arthroplasty are established treatments for the management of end-stage hallux rigidus; identifying the specific outcomes and complications associated with each can represent a challenge when consenting patients.

The dowel technique for first metatarso-phalangeal joint arthrodesis in revision surgery with bone loss

BackgroundThe operative management of failed first metatarso-phalangeal joint (MTPJ) surgery is often complicated by bone loss and shortening of the hallux. Restoration of first ray length and alignment often cannot be achieved with in situ fusion and reconstruction techniques with bone graft are therefore required. We present a novel technique of longitudinal (proximo-distal) bone dowel arthrodesis for first MTPJ arthrodesis with bone loss. MethodsBetween August 2007 and February 2015, eight patients have been treated by the senior author with this technique. The mean age at surgery was 60.5 years (range 45–80) with seven females and one male. Index surgery was MTPJ arthrodesis (three patients), Keller excision arthroplasty (two patients), MTPJ hemiarthroplasty (two patients) and silastic arthroplasty (one patient). Clinical and radiological fusion was assessed and other radiological measurements included hallux valgus angle (HVA) and length of the hallux (LOH). ResultsAll patients achieved fusion at a mean of 9.3 weeks (range 6–12) from surgery and only one patient required removal of metalwork. There were no major complications. The HVA improved in all cases from 21.4±2.8 pre-operatively to 11.6±3.5 post-operatively (p>0.05). The LOH also increased in all cases from 82.1±8.3mm to 86.7±8.2mm (p>0.05). The subgroup of patients who were revised from an arthroplasty, where maintenance of length rather than increase in length was desirable (hemiarthroplasty, silastic) had significantly lower increase in LOH than those revised from a non-arthroplasty index surgery (arthrodesis, Keller) (p=0.029). ConclusionThe dowel technique is successful for first MTPJ arthrodesis revision surgery with optimal union rates and satisfactory radiographic and clinical outcomes. It is an effective and versatile option for managing bone loss and deformity of the hallux.

Treatment of unilateral Temporomandibular joint ankylosis with silastic interpositional Arthroplasty

Background: Ankylosis is a very common condition developed mainly after damage to mandibular condyles or temporomandibular joint (TMJ) at a growing age. Different autogenous and alloplastic interpositional materials have been attempted after the resection of the ankylotic bone to achieve desirable results. This condition is relatively common in Pakistan. We treated TMJ ankylosis with alloplastic medical grade silicone "silastic" interpositional arthroplasty. Eight joints accompanied ipsilateral or contralateral coronoidectomy to achieve desirable results. Method: All patients were presented at Punjab Dental Hospital Lahore. Sixty-one joints with unilateral TMJ ankylosis were underwent surgery after careful examination and final radiographic confirmation. The preoperative CT scan was also performed in few patients. Results: The postoperative measurements of the interincisal opening with lateral and protrusive jaw movements were criteria for success of surgery. The lateral and protrusive jaw movements were assessed as excellent, good and poor. Less than 25 mm interincisal opening was considered as poor jaw opening. Conclusion: The overall success rate was 98.4 "Ai with 84 % desirable interincisal jaw opening. Less than 5 % patients were observed with poor jaw opening. The immediate late complications were transient and were included oedema, weakness of a branch of the facial nerve on the operated side. Two implants were infected along with one wire in the first month of surgery and were removed under local anesthesia` without further complication.

A Comparison of Complications of Total Wrist Fusion and Silastic Arthroplasty

The use of the Swanson silastic arthroplasty for the treatment of the rheumatoid hand has been shown to correct deformities and improve function. Silastic arthroplasty has a tendency to fracture requiring revision, while wrist fusion is thought to be a more durable solution. We conducted a retrospective case note analysis of all patients undergoing wrist arthroplasty or wrist fusion for clinical follow-up. Radiographic imaging was reviewed. Patient records on the combined GP/Hospital database were reviewed for the purpose of community follow-up. In the cohort of patients who underwent silastic arthroplasty, the indications for surgery were 14 rheumatoid arthritis, 2 psoriatic arthritis, 2 juvenile arthritis, and 3 osteoarthritis. Of the 21 patients, 17 were older than 65 years of age. There were 3 reported complications: a postoperative wound infection that required debridement, a complex regional pain syndrome, and an ongoing symptoms of pain requiring debridement of the distal radius. There were no implant fractures at last radiographic review. The 5-year survivorship was 100% with reoperation as the end point with 2 implants lasting up to 15 years. A total of 38 patients underwent a wrist fusion, with a mean age of 52 years, with 6 patients older than 65 years of age. In all, 17 were undertaken for osteoarthritis, with 1 case of avascular necrosis of the capitate in a patient with calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome. Eleven patients reported time off work as a direct result of their symptoms. Postoperative complications include hematoma, complex regional pain syndrome, distal radial ulnar joint pain requiring Darrach procedure in 4 patients, screw revision following prominence, and 4 cases where the metal ware was removed. All fusions went onto unite. Survivorship at 5 years was 91% with reoperation as the end point. This small case series shows that for this highly selected group of patients with an inflammatory arthropathy, silastic arthroplasty remains a viable option. For elderly patients having rheumatoid with low demand, this treatment has a lower reoperative rate at 5 years and therefore may often be the final treatment they require.

Swanson-type silastic arthroplasties of the PIP joint for rheumatoid arthritis . Results of 19 implants at 5.3 years of follow-up

This retrospective study reports the results from 19 PIP Silastic spacers in 11 female patients suffering from inflammatory diseases at a mean of 2.2 and 5.3 years after surgery. The improvement in range of movement decreased with time, evolving from a gain of 18̊ at 2.2 years to only a 4̊-gain at subsequent follow-up. The fracture rate was high (30%). Objective analysis by physicians reported poor or mild improvements in 75% of cases. Subjective analysis (assessing aesthetics, function and pain) by patients, showed an average score of 5.6/10. At final follow-up, eight out of nine patients did not regret having had surgery. As patients actually hope for pain relief and improved function and quality of life, rather than anatomical recovery, this explains the high acceptability and interest in this rudimentary surgical procedure.

Long-Term Follow-Up of Basal Joint Resection Arthroplasty of the Thumb With Transfer of the Abductor Pollicis Brevis Origin to the Flexor Carpi Radialis Tendon

To investigate the long-term functional and clinical outcomes of a tendon transfer during basal joint interposition arthroplasty for osteoarthritis of the basal joint of the thumb, in which the origin of the abductor pollicis brevis (APB) and opponens pollicis is transferred to the flexor carpi radialis tendon, in order to increase the abduction moment arm of the thumb and provide dynamic stabilization of the base of the first metacarpal. We observed 22 patients, who received basal joint interposition arthroplasty with APB and opponens pollicis tendon transfer, over an average of 9 years (range, 3-20 years). Subjective outcome measures included patient satisfaction scores, visual analog scale scores for pain, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Clinical evaluations included thumb range of motion, grip strength, and pinch strength. At an average follow-up of 9 years, 95% of patients (21 out of 22) subjectively scored the procedure as good or excellent and reported improvement in activities of daily living. Mean visual analog scale pain score was 4.4 at rest and 7.8 with activity (out of 100), and mean DASH score was 13.3 (out of 100). Average grip strength of the operated hand was equal to that of the contralateral hand, and lateral and tip pinch strengths were 79% and 93%, respectively, of the contralateral hand. No intraoperative or early postoperative complications were reported, although 1 patient whose procedure was performed as treatment for failed silastic arthroplasty reported metacarpal instability at 9-year follow-up (DASH score of 22). Basal joint arthroplasty with APB and opponens pollicis tendon transfers provides excellent long-term results for carpometacarpal thumb osteoarthritis. The procedure is safe, with a low complication rate. Its success has long-term durability as measured by patient satisfaction, functional outcome measures, range of motion, and strength. Therapeutic IV.

Double V-shaped Cancellous Osteotomy of the Distal Radius for Kienböck's Disease

Treatments of Kienböck's disease range from conservative measures-usually immobilization during the acute phase-to such procedures as joint leveling by radial shortening or ulnar lengthening, intercarpal fusion, silastic arthroplasty, and vascularized bone grafts. Joint-leveling procedures have many complications such as nonunion, hardware problems, and pain. In this study, 34 patients with Kienböck's disease, stage 1 through 3B in Lichtman's classification, were treated with a new technique: a double V-shaped metaphyseal osteotomy of the distal radius and dorsal tilt of the distal radius. The patients were evaluated clinically regarding pain, which decreased in 88% of patients; range of motion, which improved in all patients; and grip strength, which improved by 90%. Progression of the disease was assessed radiologically by determining the carpal height ratio and the carpal ulnar distance ratio. There were no cases with nonunion of the radial osteotomy at follow-up. This procedure is an effective treatment method for Kienböck's disease in wrists that do not have degenerative changes in the adjacent carpal joints.

Grading of Radiographic Osteolytic Changes After Silastic Metacarpophalangeal Arthroplasty and a Prospective Trial of Osteolysis Following Use of Swanson and Sutter Prostheses

Grading of Radiographic Osteolytic Changes After Silastic Metacarpophalangeal Arthroplasty and a Prospective Trial of Osteolysis Following Use of Swanson and Sutter Prostheses

The Value of Radial Collateral Ligament Reconstruction and Abductor Digiti Minimi Release in Metacarpophalangeal Joint Arthroplasty

Rheumatoid arthritis is a chronic, progressive disease characterized by destructive synovitis commonly involving the hand. Ulnar drift deformity has been reported in up to 30% of these patients. Metacarpophalangeal (MCP) joint arthroplasty with soft-tissue reconstruction was described to correct this deformity, but recurrence is a common problem. This is a retrospective study of 18 patients who underwent 96 primary index to little finger MCP joint arthroplasties in Montreal General Hospital. Patients were divided into 2 groups. In group I, 60 MCP joints in 15 hands had silastic arthroplasty with radial collateral ligament reconstruction and abductor digiti minimi release. In group II, 36 MCP joints in 9 hands had silastic arthroplasty without soft-tissue reconstruction. All patients had the same postoperative rehabilitation, with a follow-up mean time of 63 months. Postoperative clinical and radiologic comparison was performed. Group I was found to have more severe wrist disease. No significant difference was seen between the 2 groups for ulnar drift (D2, P < 0.79; D3, P < 0.11; D4, P < 0.49; D5, P < 0.31), active range of motion, power grip, incidence of MCP subluxation, or functional ability. MCP arthroplasty with radial collateral ligament reconstruction and abductor digiti minimi release may recreate a short-term balance of forces around the MCP joint but does not prevent late postoperative deformity. This is a preliminary study with a small sample size but supported previous reports on MCP arthroplasty with soft-tissue reconstruction.

Result of Arthrodesis of the Hallux Metatarsophalangeal Joint Using Bone Graft for Restoration of Length

We treated 24 patients (18 women, six men; average age, 46.4 years; (range, 28 to 66 years) with fusion of the hallux metatarsophalangeal (MTP) joint using bone graft for the restoration of the length of the first ray. This procedure was performed after bone loss subsequent to previous surgeries for the correction of hallux valgus and hallux rigidus with: silastic arthroplasty (11), bunionectomy and distal metatarsal osteotomy (six), Keller resection arthroplasty (five), and total joint replacement (two). The indication for performing the arthrodesis with bone graft was a short first metatarsal, and associated metatarsalgia of the lesser metatarsals in addition to a painful MTP joint with or without deformity. This bone loss was associated with avascular necrosis of the first metatarsal (nine patients) and with osteomyelitis (seven patients). Of the 24 patients, 14 underwent additional concurrent surgery for correction of hammer toes (10), excision of a Morton's neuroma (two), and lesser metatarsal osteotomy (two). All patients were examined clinically and radiographically at a mean interval of 62.7 months after surgery (range, 26 to 108 months). The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux and MTP 100-point outcome scale. Arthrodesis occurred in 19/24 patients (79.1%) at a mean of 13.3 weeks (range, 11 to 16 weeks), and the first ray was lengthened by a mean of 13 mm (range, 0 to 29 mm). Of the five nonunions, two were asymptomatic, and three were subsequently revised successfully, with arthrodesis occurring at a mean of 10.7 weeks. Complications included one deep infection requiring intravenous antibiotics for treatment of osteomyelitis and two minor superficial wound infections. The mean AOFAS score improved from 39 points (range, 22 to 60 points) to 79 points (range, 64 to 90 points). All patients were satisfied with the final outcome of treatment and stated that they would undergo the surgical procedure again. We concluded that arthrodesis of the hallux MTP joint with bone graft to restore bone loss and length of the first ray may be a worthwhile procedure despite the technical difficulty and the high rate of nonunion.

A PATIENT-REPORTED COMPARISON OF TRAPEZIECTOMY WITH SWANSON SILASTIC IMPLANT OR SLING LIGAMENT RECONSTRUCTION

A retrospective review of two types of operations for carpometacarpal osteoarthritis of the thumb was done for patients operated on between 1991 and 1996. Follow-up ranged from 18 to 90 months (mean 62 months). Fifty-eight Swanson Silastic arthroplasties and 56 sling excision arthoplasties were reviewed. Eight patients with Swanson arthroplasties underwent removal of the implant. Eight patients in the sling excision group required further surgery. These patients were excluded from further analysis. Questionnaires about pain, general satisfaction and function were sent to the other patients and 87 responses were received (sling 45, implant 42). In the implant group significantly better results were obtained for pain at 1 year, carrying a milk bottle and taking a handbrake off a car, and overall function. We conclude that trapeziectomy combined with Swanson implant gives better results in the short term if there are no complications of the operation.

Swanson double-stem arthroplasty of the hallux: a survivorship analysis

Summary Double-stem Swanson silastic arthroplasty was performed without grommets on the first metatarsophalangeal joints of 45 patients (62 feet). After a mean follow-up of 7 years 3 months (range, 5 years 1 month–9 years 10 months), 91% had been helped greatly with survivorship analysis revealing 94.4% implant survival at 10 years and significant improvements in scores for pain, ambulation, function and shoe wear ( P P

Silastic Metacarpophalangeal Joint Arthroplasty in Patients With Rheumatoid Arthritis

Two hundred sixty-four patients with rheumatoid arthritis were treated with 901 Swanson silastic arthroplasties of the metacarpophalangeal joints. Average followup was 8 years with a minimum of 2 years. Preoperative ulnar deviation averaged 45 degrees and improved to an average of 15 degrees postoperatively. Active flexion arc averaged 40 degrees preoperatively and 50 degrees postoperatively, an increase of 10 degrees. The extensor lag postoperatively improved to 10 degrees from 50 degrees preoperatively, placing the arc of metacarpophalangeal joint motion between 10 degrees and 60 degrees flexion. Complications included dehiscence and delayed wound healing (2%), superficial infection (0.5%), deep infection (3%), and prosthetic fracture (14%). Subjectively, most patients thought that their postoperative function was improved. This was thought to be attributable in part to the correction of the ulnar deviation deformity of the fingers, and the shifting of the arc of motion of the metacarpophalangeal joints to one allowing increased metacarpophalangeal extension, thereby improving the opening capacity of the digits and the overall function of the hand.

Hand function following Silastic arthroplasty of the metacarpophalangeal joints in the rheumatoid hand

Twenty-one consecutive rheumatoid patients (23 hands, 92 joints) who underwent Silastic metacarpophalangeal joint arthroplasty between 1989 and 1993 had the 33-task Baltimore quantitative upper extremity function test prior to surgery and then repeated at intervals from 6 weeks to 1 year for all 23 hands and 3 to 4 years for 14 of the hands. In addition all hands had goniometer measurement of active range of finger joint motion and ulnar drift at each assessment. The average preoperative score was 71 improving rapidly to 89 at 6 weeks, to 91 at 1 year and 92 at 3 to 4 years. Most improvement occurred in functions requiring pinch span or hook grip and could be attributed largely to correction of ulnar drift and the change of metacarpophalangeal arc of motion. These results confirm that the Silastic metacarpophalangeal joint arthroplasty significantly improves hand function and that the improvement is maintained over a 3- to 4-year period.

Perichondrial arthroplasty insmall joints of the hand

Perichondral arthroplasty can selectively be applied to restore function and limit pain in adolescents and youngadults with traumatic, postinfectious, or inflammatory arthritis of the small joints in the hand in cases in which more common treatments, such as silastic arthroplasty or fusion, are, undesirable alternatives.

Silastic arthroplasty in rheumatoid MCP-joints. 60 joints followed for 7 years.

16 patients with rheumatoid arthritis underwent Swanson silastic arthroplasty in 60 MCP-joints. After 7 (5-10) years only 8 patients had pain relief, 7 were satisfied, and 13 implants had fractured. We conclude that the effects of Swanson silastic arthroplasty deteriorate with time.

Revision procedures for complications of surgery for osteoarthritus of the carpometacarpal joint of the thumb

Between the years 1980 to 1987, 17 patients had revision procedures for complication s of surgery for osteroarthritis of the carpometacarpal joint of the thumb 12 followed silastic implant arthroplasty, four trapeziectomy and one arthrodesis. The failed silastic arthroplasties were treated by removal of the implant, and soft tissue arthroplasty in eight, revision with another implant in three and intermetacarpal bone grafting in one. Patients with metacarpo-scaphoid arthiritis after trapeziectomy were treated by silastic implant arthroplasty in three and fusion in one. Nine of the 17 revision procedures (53%) had good, three (18%) fair and five (29%) poor results respectively.

Long-term results of Swanson silastic arthroplasty in the rheumatoid wrist

We report a long-term follow-up of 6 to 11.8 years (mean= 8 years) of our first 50 Swanson wrist arthroplasties. All patients had long standing sero-positive rheumatoid arthritis with a mean age of 48 years. A detailed clinical and radiologic assessment was carried out on all the wrists. There was excellent sustained pain relief (mean score = 1.7) with improved activities of daily living. N mean range of wrist movement of 25° of extension and 31° of flexion was obtained. The prosthetic wrist movement of 25° of extension and 31° of flexion was obtained. The prosthetic fracture rate was 22% of which 14% were symptomatic and needed re-operation. Carpal collapse was seen in all wrists, but was often symmetrical and accompanied by radial new bone formation on X-ray (86%). We feel that our long-term results justify the continued selective use of the Swanson wrist in the low-demand patient with quiescent disease who desires pain-free limited mobility and sophisticated grasp.