Bioreconstructive Joint Scaffold Implant Arthroplasty in Metacarpophalangeal Joints: Short-Term Results of a New Treatment Concept in Rheumatoid Arthritis Patients

Abstract

Swanson silicone implant is the "gold standard" of metacarpophalangeal joint reconstruction in rheumatoid arthritis (RA) patients. However, durability problems of silicone implants have led us to develop a new technique based on bioreconstructive implants. PLA96 (poly-L,D-lactide copolymer, L:D ratio of 96:4) scaffolds were engineered. Bioabsorption and substitution of porous PLA96 scaffold with living tissue eventually produce a neojoint. In the current prospective study, 23 RA patients (80 joints) were operated on, using PLA96 implants. Fifteen patients (54 joints) have been monitored for at least 1 year. Pain alleviation was well achieved. Range of motion improvement was emphasized to extension direction of functional arc. The average ulnar deviation was preoperatively 26 degrees, and at follow-up it was 6 degrees. Volar subluxation was noticeable in 56% of joints preoperatively and in 6% at 1-year follow-up. This is the first report of the formation of a living, functional joint in situ by means of a synthetic bioreconstructive joint scaffold. Results of this preliminary short-term study are comparable with previously published data on silicone arthroplasty. However, bioreconstructive prostheses can aid in preventing problems that occur with biostable prostheses. Tissue engineering has created a new era in the reconstruction of damaged joints.

One-Year Results of Use of Poly-L/D-Lactic Acid Joint Scaffolds and Bone Packing in Revision Metacarpophalangeal Arthroplasty

“…The amount of ulnar deviation was also larger in our patients than in the mostly primary cases in the study by Honkanen et al (2003), who recorded an average ulnar deviation of six degrees at one year. The ulnar deviation in this study was 51 to 131, with this tendency being greater in the ulnar fingers.…”

“…Initial operations were carried out using commercially available bioabsorbable Vicryl and Ethisorb fleeces folded into small, rectangular scaffolds (Honkanen et al, 2003). Although the early results were promising, the resorption time of these materials proved too short and the joint space collapsed.…”

Synthesis and Characterization of Polyamide of Trans-4-hydroxy-L-proline used as Porogen Filler in Acrylic Bone Cement

“…164. 5 C. Trans-4-hydroxy-L-proline methyl ester was prepared from trans-4-hydroxy-Lproline methyl ester hydrochloride salt using an ion exchange resin. Strongly basic gel-type ion exchange resin (400 g, Amberlite IRA-400, Fluka Chemie GmbH, Buchs, Switzerland) was stirred with 500 mL of 2 M NaOH (Natriumhydroxide, Akzo Nobel, Eka Nobel AB, Bohus, Sweden) at room temperature for 5 min.…”

The Mean Seven Years' Results of the Use of Poly-L/D-Lactic Acid (PLDLA) Interposition Implant and Bone Packing in Revision Metacarpophalangeal Arthroplasty: A Prospective Cohort Study

“…This implant has yielded promising results in both primary and revision MCP arthroplasties (11)(12)(13)(14).…”