Soft tissue balancing during silicone metacarpophalangeal joint arthroplasty decreases the rate of reoperation
Jonathan Lans, MD; Bo J.W. Notermans, MD; Denise Arnold, MD; Quirine M.J. van der Vliet, MD; Jesse B Jupiter, MD; Neal C Chen, MD
Massachusetts General Hospital, Boston, MA
Background: The rate of revision after silicone MCP arthroplasty has been reported up to 35%. Factors associated with reoperation are not well understood. The goal of this study was to evaluate the factors associated with reoperation after silicone MCP arthroplasty.
Materials and Methods: We retrospectively included all adult patients that underwent arthroplasty between 1994 and 2016 at one institutional system in the Northeastern United States. After manual chart review, we included 108 patients that underwent 416 arthroplasties. Patients had been diagnosed with inflammatory arthritis (77%), primary degenerative arthritis (4.1%) or post-traumatic arthritis (4.1%). Fingers treated included 11 thumbs, 85 index-, 81 long-, 69 ring-, and 67 small fingers. To correct for a possible mutual influence of hands in bilaterally operated patients we only included fingers treated at patients initial surgery (n=315). All explanatory variables with a p-value <0.10 in bivariate analysis were included in a generalized estimating equation.
Results: The overall reoperation rate was 15% (n=46). A second and third reoperation was performed in 17 and 7 fingers, respectively. Median follow-up was 17 (IQR [4.9, 50]) months. Indications for reoperation were implant breakage (n=18), deformity (n=5), infection (n=5), stiffness (n=5), instability (n=4), heterotopic ossification (n=2) and soft tissue complications (n=5). Additional procedures performed at the index operation was independently associated with no reoperation (p=0.040). The most frequently performed additional surgery was collateral ligament reconstruction (n=143). Complications included ulnar deviation (37%), stiffness (53%), extensor tendon related problems (25%), volar plate contracture (18%) and wound problems (8%). The 2-, 5- and 10-year implant survival rates were 90%, 82% and 66%, respectively.
Conclusion: The reoperation rate after silicone MCP joint arthroplasty was 15% in this study. Additional surgery appeared to reduce the risk of reoperation. This highlights the fact that periarticular soft tissue stabilization may play a role in the success of silicone MCP joint arthroplasty.
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