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Revision Metacarpophalangeal Arthroplasty; 128 Consecutive Cases
Eric Wagner, MD1; Matthew Houdek, MD1; Daryl Kor, MD1; Steven L. Moran, MD2; Marco Rizzo, MD3
1Mayo Clinic, Rochester, MN; 2Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN; 3Division of Hand Surgery, Mayo Clinic, Rochester, MN

Purpose: Primary metacarpophalangeal (MCP) arthroplasty is an established treatment for MCP arthritis, and as with all total joint replacements, it is not unusual to require revision arthroplasty. There is a paucity of literature examining incidence, prognosis and outcomes following MCP revision arthroplasty. The objective of this study was to assess the results revision MCP arthroplasty, identifying factors associated with improved outcomes.

Methods: Utilizing the institutional Joint Registry Database, 128 revision MCP arthroplasties were performed in 64 patients at our institution from 1998 to 2012. The average age at surgery was 62.2 years, average BMI 31.5. There were 83 with patient's rheumatoid arthritis (RA) and 6 with Juvenile RA, while 46 patients were using prednisone and 31 methotrexate at the time of surgery. There were 50 were non-constrained (30 pyrocarbon and 19 metal-plastic) and 78 constrained silicone implants. Cement was used in 20 and bone graft in 9. 13 patients had a history of preoperative flexion contractures, while 8 had MCP instability.

Results: At an average 5.1 years of follow-up, there were 19 (15%) repeat revision surgeries performed. Reasons for revision surgery included: dislocation (11), pain with limited motion (4), silicone synovitis and bone resorption (2), infection (1), and metacarpal component loosening (1). The 2, 5 and 10 year survival rates were 89%, 80%, and 78%, respectively (Figure 1). Patients that had a history of DM and prior instability had an increased risk of implant failure (p<0.01). There were 3 intraoperative complications involving periprosthetic fractures, including 2 in the proximal phalanx and 1 in the metacarpal. Only 1 of the fractures required circumferential suture stabilization. There were 11 (9%) postoperative complications, including 8 MCP dislocations, 1 heterotopic ossification, 1 postoperative fracture and 1 infection. Furthermore, 31 (24%) developed flexion contractures. SRA implants (p<0.05) and instability (p<0.02) were associated with increased rates of infection, while implants in the dominant extremity (p<0.04) were associated with increased rates of flexion contractures. The rates of postoperative dislocation were higher in female patients (p<0.04), smokers (p<0.02), and SRA implants (p<0.03).

Summary Points: Revision MCP arthroplasty is a challenging procedure with a 5 year survival of 80% and a relatively high rate of complications and flexion contractures. Worse outcomes are seen in in patients with a history of MCP dislocations, smokers, and SRA implants. With increasing use of MCP arthroplasty, there is a need for innovative strategies to optimize long-term outcomes in revision MCP arthroplasty.

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