Silicone rubber implant arthroplasty of the metacarpophalangeal joint in rheumatoid arthritis: A follow-up study of 32 patients

doi:10.1016/S0363-5023(86)80138-1

The Journal of Hand Surgery

Volume 11, Issue 3, May 1986, Pages 333-339

https://doi.org/10.1016/S0363-5023(86)80138-1 Get rights and content

A retrospective analysis of silicone rubber implant arthroplasty of the metacarpophalangeal joint in 32 patients with rheumatoid arthritis is reported. One hundred seven implants were followed in 37 hands for an average of 44 1/2 (12 to 120) months. Active motion of the metacarpophalangeal joint averaged 34°, with a mean extension deficit of 7° and a mean flexion 41 °. Ulnar deviation recurred to more than 10° in 33 of 107 fingers (31%). Fracture of the spacer was confirmed in four joints (4%). One fracture of the proximal phalanx and one of the metacarpal head had occurred. Bone resorption around the stem or a hinge and migration of the implant were found in 26 (24%) fingers. Patient satisfaction was high; 27 patients experienced significant pain relief, the functioning of 31 hands (84%) was improved, and 28 patients (32 hands) thought that the cosmetic appearance of the hand was improved.

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There are more references available in the full text version of this article.

Cited by (63)

Metacarpophalangeal Joint Arthroplasty
2016, Hand and Upper Extremity Rehabilitation: A Practical Guide
NeuFlex and Swanson Metacarpophalangeal Implants for Rheumatoid Arthritis: Prospective Randomized, Controlled Clinical Trial
2010, Journal of Hand Surgery
To compare postoperative range of motion (ROM) and function in a randomized prospective trial of Swanson and NeuFlex metacarpophalangeal (MCP) joint implants.
A total of 33 patients who had rheumatoid arthritis underwent primary MCP arthroplasty of all 4 fingers in 40 hands; 20 received Swanson implants and 20 received NeuFlex implants. Exclusion criteria included diagnosis of other connective tissue disorders and previous MCP joint surgery. All participants followed the same postoperative rehabilitation protocol. The primary outcome measure was active MCP flexion. Secondary outcomes included active MCP extension, arc of motion, ulnar drift, function (Jamar grip strength and Sollerman hand function test), and the Michigan Hand Questionnaire. Patients were assessed preoperatively and 12 months postoperatively.
Patients' mean age was 62.5 years (Swanson) and 58.1 years (NeuFlex) (p = .03). A total of 19 of 20 hands (Swanson) and 14 of 20 hands (NeuFlex) were from female patients. Preoperative active ROM was not significantly different. At follow-up, both groups demonstrated increased active extension and arc of motion (p < .001), reduced active flexion and improved ulnar deviation (p < .001), increased mean Sollerman and Michigan Hand Questionnaire domain scores (p < .001), and improved grip strength (p = .03). Active MCP flexion was significantly greater in all 4 digits of hands with NeuFlex implants compared with Swanson implants. The NeuFlex group demonstrated a greater total arc of motion in the little finger. Implant groups were not significantly different by individual digit for active MCP extension, ulnar drift, and composite flexion. Functional outcomes did not differ between groups. Patients with Swanson implants reported higher Michigan Hand Questionnaire scores in the function and aesthetics domains.
Both implant groups obtained satisfactory clinical improvement after MCP reconstruction of the hand. The NeuFlex group demonstrated superior ROM, whereas the Swanson group had better self-reported function and aesthetics, but not objectively measured function.
Therapeutic I.
Outcomes of Silicone Arthroplasty for Rheumatoid Metacarpophalangeal Joints Stratified by Fingers
2009, Journal of Hand Surgery
Previous studies have demonstrated that outcomes for the ulnar digits appear to be worse than those of the radial digits after silicone metacarpophalangeal joint arthroplasty (SMPA) for the rheumatoid hand. This study examines various components of hand deformities in an effort to understand SMPA outcomes in terms of metacarpophalangeal (MCP) joint range of motion and alignment. We hypothesize that the ulnar fingers will have less improvement, marked by greater ulnar drift, extension lag, and less MCP joint arc of motion than the radial fingers.
Sixty-eight surgical patients were recruited from 3 sites in this multicenter, international prospective cohort study. All patients had a diagnosis of rheumatoid arthritis, were between the ages of 18 and 80, and were eligible to have SMPA based on measured hand deformities (extensor lag and ulnar drift). Ulnar drift, extension lag, and arc of motion for the MCP joint of each finger were measured at baseline (before surgery) and 1 year after SMPA.
All fingers showed an improvement in ulnar drift from baseline to 1 year after surgery. The smallest improvement was in the index finger, and the largest improvement was in the little finger. Similarly, the largest improvement in extension lag was seen in the little finger, and the smallest improvement was seen in the index finger. In terms of MCP joint arc of motion, all fingers moved to a more extended posture and gained an improved arc of motion, but the biggest improvement was observed in the 2 ulnar fingers and less in the 2 radial fingers.
Our hypothesis that the ulnar fingers would have worse outcomes than the radial fingers was not proven by this study. Although experiences have indicated that it is more difficult to maintain posture for the ring and little fingers after SMPA owing to the deforming forces, sufficient correction of the deformities in the ulnar fingers is possible, if adequate bone resection and realigning of the extensor mechanism are carefully performed during the procedure.
Prognostic I.
A Multicenter Clinical Trial in Rheumatoid Arthritis Comparing Silicone Metacarpophalangeal Joint Arthroplasty With Medical Treatment
2009, Journal of Hand Surgery
Metacarpophalangeal (MCP) joint deformities caused by rheumatoid arthritis can be treated using silicone metacarpophalangeal joint arthroplasty (SMPA). There is no consensus as to whether this surgical procedure is beneficial. The purpose of the study was to prospectively compare outcomes for a surgical and a nonsurgical cohort of rheumatoid arthritis patients.
The prospective study was conducted from January 2004 to May 2008 at 3 referral centers in the United States and England. Over a 3-year period, 70 surgical and 93 nonsurgical patients were recruited. One year data are available for 45 cases and 72 controls. All patients had severe ulnar drift and/or extensor lag of the fingers at the MCP joints. The patients all had 1-year follow-up evaluations. Patients could elect to have SMPA and medical therapy or medical therapy alone. Outcomes included the Michigan Hand Outcomes Questionnaire (MHQ), Arthritis Impact Measurement Scales, grip and pinch strength, Jebson-Taylor test, and ulnar deviation and extensor lag measurements at the MCP joints.
There was no difference in the mean age for the surgical group (60) when compared to the nonsurgical group (62). There was also no significant difference in race, education, and income between the 2 groups. At 1-year follow-up, the mean overall MHQ score showed significant improvement in the surgical group but no change in the nonsurgical group, despite worse MHQ function at baseline in the surgical group. Ulnar deviation and extensor lag improved significantly in the surgical group, but the mean Arthritis Impact Measurement Scales scores and grip and pinch strength showed no significant improvement.
This prospective study demonstrated significant improvement for RA patients with poor baseline functioning treated with SMPA. The nonsurgical group had better MHQ scores at baseline, and their function did not deteriorate during the 1-year follow-up interval.
Therapeutic III.
Results of Revision Metacarpophalangeal Joint Surgery in Rheumatoid Patients Following Previous Silicone Arthroplasty
2007, Journal of Hand Surgery
Primary silicone metacarpophalangeal (MCP) joint arthroplasties have good results that deteriorate with time. The purpose of this study was to assess indications, patient satisfaction, and clinical and radiographic results following revision surgery in rheumatoid patients who had previously undergone silicone MCP arthroplasty.
Twenty hands in 18 patients (62 implants) had revision silicone MCP arthroplasties between 1986 and 2005 and had a greater than 1-year follow-up period (mean 5 y). A retrospective chart review was performed to collect preoperative and intraoperative data. Patients were then re-examined and administered a questionnaire addressing subjective outcome and satisfaction.
Intraoperatively, 76% of the implants were fractured. Thirteen of 17 synovial biopsies revealed giant cell foreign body reaction. Preoperatively, the average arc of motion was from 16° to 50°, and ulnar drift was 24°. Postoperatively, the average arc of motion was from 20° to 54°, and ulnar drift was 13°. X-rays of 14 hands revealed that 15 of 44 revised implants had fractured. Sixteen patients (18 hands) were available to complete questionnaires. Twelve patients (14 hands) were satisfied and 3 were dissatisfied. Five of 16 patients would not have the revision again. These patients had worse average postoperative ulnar drift (30° vs 9°) than the other 11 patients. All patients except one who had preoperative pain had at least moderate pain relief, and of the 6 patients who had revision surgery because of pain, 5 were satisfied.
Revision silicone arthroplasty provides excellent pain relief, and the majority of patients were pleased with their results. Objective results, however, were generally poor. Soft tissue reconstruction is more difficult to achieve than the primary procedure, as evidenced by minimal improvement in ulnar drift, a high rate of implant fracture, and no change in arc of motion.
Therapeutic IV.
Silastic metacarpophalangeal joint arthroplasty
2006, International Congress Series
Citation Excerpt :
Finally 82% thought that the cosmetic appearance had improved. In a similar study from Finland in 1986 Vahvanen and Viljakka [23] reported their results in 107 implants followed up for almost 45 months. Active movement reached 34°, ranging from 7° of extension to 41° of flexion.
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.

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Silicone rubber implant arthroplasty of the metacarpophalangeal joint in rheumatoid arthritis: A follow-up study of 32 patients

Surg Clin North Am

Surg Clin North Am

Surgical treatment of rheumatoid deformities of the hand

J Bone Joint Surg [Am]

The rheumatoid hand

Clin Orthop

The care of the rheumatoid hand