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The Impact of Age on Metacarpophalangeal Arthroplasty; An Analysis of 689 Consecutive Arthroplasties
Eric R. Wagner, MD; William Robinson, MD; John Weston, MD; Steven L. Moran, MD; Marco Rizzo, MD
Mayo Clinic, Rochester, MN

Purpose: The purpose of this investigation was to assess the association between a young age and MCP arthroplasty outcomes.

Methods: 689 consecutive primary MCP arthroplasties were performed in over a 14-year period, with an average age of 60 years (14-88). There were 283 arthroplasties performed in patients <60 years of age. Comparing these younger patients to patients >60 years, there were similar preoperative diagnoses and implants utilized in the two age groups. Additionally, in the younger vs. older group, there 2% (vs. 3%) were laborers in the young group.

Results: 50 MCP arthroplasties that required revision surgery, including 35 in young patients (<60 years) at a mean 4.6 years for recurrent ulnar deviation and pain (n=7), dislocation (n=27), and implant loosening (n=1). Risk of revision surgery was associated with younger ages (HR 0.97, p=0.001). The 2, 5, and 10-year implant survival rates for the patients <60 years were 97%, 91%, and 81%, respectively, which was worse than older patients (97%, 97%, 94%, HR 3.13, p<0.001). Patients younger than 55 year had an even higher risk of revision surgery (HR 3.47, p<0.001) (Figure 1). There was no difference when comparing age brackets under 60 years. Amongst the patients younger than 60 years, the use of silicone implants decreased the risk of revision surgery (Table 1). Surgical diagnosis and laborer did not impact revision surgery risk in all patients or younger patients (Figure 2). Complications in the younger patients included dislocation (n=36), infection (n=2), intraoperative (n=13) and postoperative (n=4) fractures. 65 fingers had recurrent ulnar deviation. The risk of dislocation was increased in younger patients overall and in those sub-grouped under 60 years (p<0.001). In these younger patients, use of silicone decreased the risk of dislocation. In unrevised patients at a mean 6.0 years follow-up (1-16), preoperative to postoperative pain levels significantly improved in patients <60 years (p<0.001). MCP total arc of motion did not significantly improve from 38o preoperatively to 41o postoperatively (p=0.30), and there was significant improvement in pinch or grip strength. Patients > 60 had improved MCP arc of motion compared to younger patients (p=0.01).

Conclusion: MCP arthroplasty in patients younger than 60 years have worse outcomes, independent of their occupation or diagnosis. Silicone implants have improved outcomes in younger patients. However, MCP arthroplasty predictably relieves pain and preserves motion with relatively low complications in these younger patients.

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