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Metacarpophalangeal Arthroplasty for the Management of Inflammatory Arthritis; An Analysis of 583 Arthroplasties
Eric Wagner, MD; Matthew Houdek, MD; Robert Van Demark, MD; Steven L. Moran, MD; Marco Rizzo, MD
Mayo Clinic, Rochester, MN

Hypothesis: Metacarpophalangeal (MCP) arthroplasty has shown promise in treating inflammatory arthritis, however, there is a lack of studies comparing different implant designs and their effect on function. The purpose of this study was to assess the outcomes of MCP joint arthroplasty in inflammatory arthritis, with a comparison of the 3 most common types of implants.

Methods: Utilizing a single institution's joint registry, we examined 583 MCP arthroplasties performed in 142 patients with inflammatory arthritis from 1998 to 2012. The mean age at surgery was 61 years and a BMI of 25.63% involving the dominant extremity.86% were females, 11% smokers, and 12% had diabetes mellitus (DM). Implant types included pyrocarbon (n=155), silicone (n=366), and SRA (n=61). Patient characteristics comparisons, with the exception of age, did not differ significantly between implants. For pyrocarbon, SRA, and silicone groups age averaged (53, 54, 65), females (81%, 89%, 88%), smokers (12%, 0%, 11%), and DM (12%, 3%, 11%).

Results: There were 38 revision surgeries performed at a mean 2 years postoperatively. The 2, 5 and 10 year survival rates were 98%, 95%, and 87%, respectively. The 5-year survival rates for the pyrocarbon, SRA, and silicone implants were 91%, 84%, and 99%, respectively (Figure 1, silicone (blue), pyrocarbon (red), and SRA (green)). Patients receiving a SRA (HR 3.42, p<0.001) and pyrocarbon (HR 2.60, p=0.005) had an increased risk of revision arthroplasty compared to silicone implants. Intraoperative fractures and use of cement also increased implant failure risk (Table 1). There were 15 intraoperative complications involving a periprosthetic fracture, while postoperative complications included 19 dislocations, 2 heterotopic ossifications, 4 postoperative fractures and 9 infections. Pyrocarbon implants were associated with an increased rate of dislocation (p<0.001) and HO (p=0.02). In those unrevised patients, at a mean 5 years (2-10) follow-up, preoperative to postoperative pain levels significantly improved (p<0.01). In unrevised implants, there was no significant change in total arc of motion, grip or pinch strength when compared to preoperative values. SRA implants were associated with a increased total arc of motion (51o) compared to pyrocarbon (42o) and silicone (44o) (p=0.005).

Summary Points: MCP arthroplasty for inflammatory arthritis can be a successful motion sparing procedure with reasonable medium term survival and low complications. Silicone prosthesis was associated with a higher survival rate than pyrocarbon or SRA. Patients experience predictable pain relief and maintenance of their motion.

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