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Avanta Preflex Silastic Implant in Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis
Shosuke Akita, MD; Koji Yachi, MD; Shigeyoshi Tsuji, MD; Jun Hashimoto, MD
Osaka Minami Medical Center, Kawachinagano, Japan

Objectives: Silicone metacarpophalangeal (MP) joint arthroplasty is a valuable option for the treatment of ulnar drift in the hands of patients with rheumatoid arthritis (RA). There are two designs for silicone MP joint arthroplasty. One is the straight type (Swanson or Avanta/Sutter), and the other is the preflexed type (NeuFlex or Avanta Preflex). There are many reports of the results with each implant. However, to the best of our knowledge, there have been no previous reports about the results of the Avanta Preflex implant. The purpose of this study was to evaluate the short-term outcomes when the Avanta Preflex implant was used to treat RA patients with ulnar drift.
Methods: A retrospective review of Avanta Preflex silicone MP joint arthroplasties was performed in 20 patients (26 hands, 94 implants) with RA. Patients were evaluated at an average of 48 months (minimum follow-up period, 24 months). Objective results included grip strength, ulnar drift, extensor lag, and arc of motion measurements at the MP joints. Preoperative and postoperative data for grip strength, ulnar deviation, and finger motion were compared using the paired two-group t-test. The level of significance was set at p<0.05. The radiographs were obtained at the time of latest follow-up for all fingers, and were reviewed for implant fractures. Subjective results were evaluated with visual analogue scale (VAS) scores, which measured pre- and postoperative pain at rest and during use, hand function, and cosmetic appearance. Patient satisfaction was noted.
Results: The mean grip strength improved from 0.5 kg preoperatively to 1.2 kg at the time of final follow-up (p < 0.001). The mean ulnar drift improved from 33 preoperatively to 7 at the time of final follow-up (p < 0.001). The mean arc of motion of the MP joints improved from 33 preoperatively to 52 at the time of final follow-up (p < 0.001). The mean extension deficit of the MP joints improved from 46 preoperatively to 14 at the time of final follow-up (p < 0.001). There were no implant fractures in any of the fingers. The VAS assessments (0-10) showed overall decreases in pain at rest and with use and improvements in hand function and cosmetic appearance. Statistical analysis showed a significant improvement in cosmetic appearance (P = 0.01). Eighteen patients (90%) were satisfied with their results.
Conclusion: The Avanta Preflex implant appears to give similar results to those obtained with other silicone implants in RA patients.


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