Bioreconstructive Poly-L/D-Lactide Implant Compared With Swanson Prosthesis in Metacarpophalangeal Joint Arthroplasty in Rheumatoid Patients: a Randomized Clinical Trial

Honkanen, Petri; Tiihonen, R.; Skyttä, Eerik; Ikävalko, Mikko; Lehto, Matti; Konttinen, Yrjö T.

doi:10.1177/1753193410375777

Cited by 17 publications

(15 citation statements)

References 25 publications

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“…Due to severe osteolysis, bone perforations and diverse soft tissue problems were encountered during revision surgery in our patients , a new silicone implant is not an ideal option in revision MCP arthroplasty. The PLDLA interposition arthroplasty aims to avoid the foreign body reaction , prosthesis wear or fracture complications associated with the use of silicone implant (10,12,13).…”

Section: Discussionmentioning

confidence: 99%

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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

Tiihonen

Honkanen

Belt³

et al. 2012

Scand J Surg

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Background and Aims: revision arthroplasty of metacarpophalangeal (mcp) joints in chronic inflammatory arthritis patients after silicone implants is challenging due of severe bone loss and soft tissue deficiencies. The aim of this study was to evaluate the outcome of revision mcp arthroplasty using poly-l/D-lactic acid 96:4 (plDla) interposition implant and morcelised allograft or autograft bone packing in patients with failed mcp arthroplasties and severe osteolysis.Material and Methods: The study group consisted of 15 patients (15 hands and 36 joints) at a mean follow-up of seven years (range 5-10 years). The radiographs were reviewed for osteolysis and incorporation of the grafted bone. The clinical assessments included active range of motion, evaluation of pain, subjective outcome and assessment of grip power.Results: plDla interposition arthroplasty combined with bone packing provided satisfactory pain relief, but function was limited. radiographic analysis showed complete incorporation of the grafted bone to the diaphyseal portion of the host metacarpal and phalangeal bones in 30 of the 36 joints. all the patients had very limited grip strength, both on the operated and non-operated side.Conclusions: Due to soft tissue deficiencies long-term function and alignment problems can not be resolved with plDla interposition implant.

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Section: Discussionmentioning

confidence: 99%

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

Section: Introductionmentioning

confidence: 99%

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

Tiihonen

Honkanen

Belt³

et al. 2012

Scand J Surg

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“…14-17 More recently, high level of evidence (level 1) has come from two randomized controlled trials (RCTs) that compared SMPA to other implants. 18,19 The sample sizes for these RCTs were small, ranging from 33 to 52 patients, whereas the retrospective studies ranged from 28 to 264 patients. Follow-up time varied by study type with retrospective studies having longer follow-up (average range 2 and 14 years) whereas prospective studies (average range 1-3 years) and RCT’s (range 1-2 years) had shorter follow-up.…”

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confidence: 99%

Long‐term followup for rheumatoid arthritis patients in a multicenter outcomes study of silicone metacarpophalangeal joint arthroplasty

Chung¹,

Burns²,

Kim³

et al. 2012

Arthritis Care & Research

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Objective Rheumatoid arthritis often results in deformities at the metacarpophalangeal (MCP) joint. Patients with severe deformities can be treated by silicone metacarpophalangeal joint arthroplasty (SMPA). The objective of the study is to prospectively compare long-term outcomes for a SMPA surgical and a non-surgical cohort of rheumatoid arthritis patients. Methods A total of 67 surgical and 95 nonsurgical patients with severe subluxation and/or ulnar drift of the fingers at the MCP joints were recruited from 2004-2008 in this multi-center prospective cohort study. Patients could elect to undergo SMPA or not. Outcomes included the Michigan Hand Outcomes Questionnaire (MHQ), Arthritis Impact Measurement Scales (AIMS2), grip/pinch strength, Jebson-Taylor test and ulnar deviation, extensor lag and arc of motion measurements at the MCP joints. Results There was no significant difference in the mean age, race, education, and income at baseline between the two groups. Surgical subjects had worse MHQ function and functional measurements at baseline. At 3 years, the mean overall MHQ score and the MHQ function, activities of daily living, aesthetics and satisfaction scores showed significant improvement in the surgical group compared to the non-surgical group. Ulnar deviation, extensor lag and arc of motion in the MCP and PIP joints also improved significantly in the surgical group. No improvement was seen in the mean AIMS2 scores and grip/pinch strength. Complications were minimal with a fracture rate of 9.5%. Conclusion RA patients with poor baseline functioning showed long term improvement in hand function and appearance following treatment with SMPA compared to non-surgical controls.

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“…Bioresorbable poly-L/D-lactide implants were recently developed for use in small joint arthroplasty. Although range of motion and pain relief are similar to Swanson implants (70), there is no risk of implant fracture, foreign body reaction, and periimplant osteolysis. These implants were designed to offer temporary support to guide soft tissue ingrowth.…”

Section: Advances In Small Joint Arthroplasty Of the Handmentioning

confidence: 96%

Advances in Small Joint Arthroplasty of the Hand

Adkinson

Chung

2014

Plastic and Reconstructive Surgery

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Substantial effort has been directed at the development of small joint prostheses for the hand. Despite advances in prosthetic joint design, outcomes have been relatively unchanged over the past 60 years. Pain relief and range of motion achieved after surgery have yet to mirror the success of large joint arthroplasty. Innovations in biotechnology and stem cell applications for damaged joint surfaces may someday make prostheses obsolete. The purpose of this review is to describe the current status, ongoing advances, and future of small joint arthroplasty of the hand.

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Bioreconstructive Poly-L/D-Lactide Implant Compared With Swanson Prosthesis in Metacarpophalangeal Joint Arthroplasty in Rheumatoid Patients: a Randomized Clinical Trial

Cited by 17 publications

References 25 publications

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

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

Long‐term followup for rheumatoid arthritis patients in a multicenter outcomes study of silicone metacarpophalangeal joint arthroplasty

Advances in Small Joint Arthroplasty of the Hand

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