Arthroplasty in Proximal Interphalangeal and Metacarpophalangeal Joints, Functional Outcome in Mid-Term Follow-Up
Alberto De Mas, MD; Francesco Kostoris, MD; Bruno Gaspardini, MD
Trieste University, Trieste, Italy
Introduction Recent years have seen finger joint replacement for the treatment of inflammatory or degenerative osteoarticular diseases become a valid alternative in patients carrying out manual precision work and requiring good finger mobility. Two types of prostheses are implantable both at the level of the metacarpophalangeal and of the interphalangeal proximal or distal articulation: resurfacing anatomic prostheses and dynamic spacers. Among these, the one we used more frequently was the Swanson implant while the most frequently used anatomic prostheses were of the titanium alloy, SR type. Materials and methods In this study, we report the results of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints replacement performed on 18 patients. A total of 20 primary replacements were performed, 12 were Swanson and 8 metallic. The mean follow-up was 27.2 months, the mean age of patients was 60.35 years. Several parameters were evaluated with clinical examination and QuickDASH and Likert questionnaires. Results In the metacarpophalangeal joint anatomic prostheses ensure good stability: all implants were resistant to the varus and valgus stress test; moreover, only a minimal difference emerged between average active and passive ROM (83° against 84°). The Swanson prostheses achieve lower results in terms of mobility (AROM = 15°, PROM = 45°). These prostheses show reduced stability to the varus and valgus stress test (present in only 50% of cases). In the interphalangeal joint we used mainly Swanson implants (10 out of 13). The average AROM was 35°, the passive was 58°. 70% of Swanson implants were stable to the varus and valgus stress test, but 90% of patients had an average axial deviation of 18.3°. The anatomic resurfacing prosthesis showed minimal differences between active and passive ROM both in the PIP joint and in the MCP joint. The QuickDASH score was, on average, 28.43 (range: 0-84.4; median: 17.05). The results were better in the MCP prostheses (13,1) in comparison with the PIP implants (36,68). Conclusion Swanson prostheses find their main indication in cases of rheumatoid arthritis, where soft tissue support capability is reduced and where they provide pain relief. In cases of osteoarthritis with integrity of the ligamentous structures, MCP anatomic implants show a better performance in terms of articular mobility and stability.
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