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Dorsal Capsule Interposition Arthroplasty for Isolated Osteoarthritis of the Metacarpophalangeal Joint
Kent Walker, DO; Jeffrey A Marchessault, MD
Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Kingsport, TN
Introduction: Current recommendations for isolated osteoarthritis of the metacarpophalangeal (MCP) joint are generally confined to implant arthroplasty to preserve joint motion and provide pain relief. Previous soft tissue interposition arthroplasty techniques utilized the volar plate with varying degrees of bone resection, motion, and pain relief. The purpose of this study was to document the median two year results of a novel soft tissue arthroplasty technique that interposes the dorsal capsule while preserving bone stock, the collateral ligaments and volar plate.
Methods: IRB approval was obtained. A retrospective review of 10 MCPJ dorsal capsule interposition arthroplasties was carried out. Exclusion criteria included rheumatoid arthritis. Post-operative follow up physical evaluation assessed MCPJ range of motion, grip strength and pain. Outcome tests used were the Michigan Hand Outcome Score and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). Visual Analog Scale was used to assess pain at time of follow up. Kellgren and Lawrence Classification was used to assess severity of MCPJ osteoarthritis on clinic radiographs.
Results: Mean follow up of 29 months from surgery. Mean age of patient was 60. The average visual analog score was 2.75/10 post operatively compared to 8/10 pre operatively. Average post-operative range of motion improved seven degrees. Average grip strength was 15 pounds less than opposite side. The QuickDASH average score at final follow up was 25.3. Final follow up score of Michigan Hand Outcome was 76. Patients with grade 2 or 3 osteoarthritis assessed by the Kellgren and Lawrence classification had the best QuickDASH and Michigan Hand Outcome scores. One patient had a digital nerve paresthesia that completely resolved. All patients working before surgery returned to work. No patient required a second surgery.
Conclusion: Our novel technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow up of two years. Pain, more than loss of function, was the most significant factor when determining patient satisfaction. Severity of osteoarthritis of the joint may be a limiting factor in this technique. These results compare favorably to previously published data on two year follow up of MCPJ pyrocarbon fiber implant arthroplasty. The advantages of this procedure include preservation of bony anatomy, collateral ligaments and volar plate so as to not preclude later implant arthroplasty.
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