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Silicone Metacarpophalangeal Arthroplasty: A Matched Cohort of Osteoarthritis and Rheumatoid Arthritis Patients
Zoe Postal, BS
1, Adam Schluttenhofer, BS
1, Audrey Bankes, BS
1; Marco Rizzo, MD
2(1)Mayo Clinic, Rochester, MN, (2)Division of Hand Surgery, Mayo Clinic, Rochester, MN
Introduction: Silicone MCP arthroplasty outcomes are well-documented for rheumatoid arthritis (RA), but reports in patients with osteoarthritis (OA) are sparse and little is known about how outcomes compare to patients with RA. We sought to compare rates of implant revision, reoperations, and complications after primary silicone MCP arthroplasty in a propensity-matched cohort of OA and RA patients.
Materials & Methods: We used our institution's prospective joint registry to retrospectively identify all primary silicone MCP arthroplasties from 2004-2022. OA joints were propensity matched 2:1 to RA joints based on age, sex, digit, dominant-side surgery. We compared Kaplan-Meier survival free from revision, all-cause reoperation, radiographic coronal plane deviation >10º, as well as complication rates.
Results: After propensity matching, there were 46 joints (33 patients) with OA with an average follow-up of 6.4 years and 138 joints (81 patients) with RA with an average follow-up of 7.1 years. There was no statistically significant difference in survival free from revision (p = 0.71) or reoperation (p = 0.99) between groups (Figures 1 & 2). 15-year revision-free survivorship was 93.2% for OA patients and 89.7% for RA patients. However, mean time to revision (0.6 vs. 5.2 years; p=0.02) and any reoperation (0.5 vs. 3.6 years; p=0.02) was significantly shorter in the OA group. Revisions in the OA group were for early complications (one infection, two contractures), while RA revisions were for long-term complications, most commonly recurrent ulnar deviation/soft tissue contracture (4 of 8). Osteoarthritis patients had significantly less final follow-up coronal deviation (6.5º vs 15.6º, p <0.001) and higher survival free from >10º deviation than RA patients (Figure 3). Complication rates did not differ significantly (20% OA, 33% RA, p = 0.17).
Conclusions: Osteoarthritis patients had earlier revisions and reoperations due to short-term postoperative complications, but did not experience the late failures or recurrent coronal deviation seen in RA patients. Silicone MCP arthroplasty provides comparable long-term survivorship in both OA and RA patients and remains a durable option in either setting for advanced MCP arthritis.
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