Long term outcomes of Silicone MCP arthroplasty: a longitudinal analysis of 325 cases
Chelsea C Boe, MD1; Eric Wagner, MD2; Marco Rizzo, MD2; (1)Mayo Clinic, Rochester, MN, (2)Orthopedics, Mayo Clinic, Rochester, MN
Introduction: The objective of this study was to examine a large prospective group of patients who underwent metacarpophalangeal (MCP) arthroplasty utilizing silicone prosthesis to characterize long term outcomes functionally and radiographically.
Methods: An analysis of 325 consecutive MCP arthroplasties in 113 patients was prospectively collected using an institution's total joints registry over 14 years (1998 -2012). Demographics included average age of 64 years, BMI 25 kg/m2, 86% females, 15% with diabetes mellitus (DM), 3% laborers, and 49% involving the dominant extremity. Diagnoses included inflammatory arthritis (n=309), post-traumatic arthritis (n=5), and osteoarthritis (n=11).
Results: Of the 325 arthroplasties performed, 62 were excluded for inadequate follow up. Of the remaining 263, 21 (8%) patients underwent revision. Complications included 27 dislocations (8%), 7 infections (2%) and 6 intraoperative fractures (2%). The 5, 10 and 15-year survival rates free from revision were 98%, 95%, and 95%, respectively. Radiographic follow up of 2 years was available for 214 arthroplasties. The 5, 10 and 15-year survival rates free from radiographic implant fracture were 93%, 58% and 35%, respectively. The 5, 10 and 15-year survival rates free from coronal plane deformity >10? were 81%, 37% and 17%, respectively. In revision free patients, mean follow-up of 7.2 years, there were improvements in pain level (p=0.03), as well as MCP arc of motion from 33o to 43o (p<0.001). Neither implant fracture, nor coronal plane deformity >10? had significant association with pain level or arc of motion.
Discussion and conclusion: MCP arthroplasty using a silicone implant demonstrates excellent long term survival. While coronal plane deformity and radiographic evidence of implant fracture increase substantially over time, these do not result in worse functional outcomes. Overall, patients experience pain relief and improved range of motion though silicone implants do not appear to protect from progression of coronal plane deformity and have a high fracture rate.
Figure 1. Survival. The revision free survival was 98% at 5 years, 95% at 10 years and 95% at 15 years.
Figure 2. Radiographic Survival. Survival free of radiographic fracture was 93% at 5 years, 58% at 10 years and 35% at 15 years.
Figure 3. Survival free of coronal plane deformity>10?. Survival free of significant coronal plane deformity was 81% at 5 years, 37% at 10 years and 17% at 15 years.
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