Flexible implant arthroplasty for arthritic finger joints

Swanson, Alfred B.

doi:10.1097/00006534-197301000-00042

Cited by 56 publications

(94 citation statements)

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“…While Swanson has shown bone build up around MP implants in cases of rheumatoid arthritis, the reverse occurs in patients with arthritis mutilans [10,13].…”

Section: Discussionmentioning

confidence: 99%

Failure of Small Joint Arthrodesis from Resorption Around a Compression Screw in a Patient with Lupus-Associated Arthritis Mutilans: Case Report

Aliu

Netscher

Peltier

2007

Hand (New York, N,Y.)

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We report the unusual case of a patient with systemic lupus erythematosus (SLE)-associated arthritis mutilans. Arthritis mutilans is a variant of erosive arthritis that is more commonly reported with psoriatic and rheumatoid arthritis and not with SLE. Joint fusion has been shown to be the most effective measure to preserve bone length and prevent further erosive joint changes in arthritis mutilans. We attempted to enhance success of a thumb interphalangeal joint fusion in our patient by adding compression across the fusion with implant screws, given the difficulty of achieving solid bone fusion ordinarily. Osteolysis around the compression screw resulted in arthrodesis failure. We were finally able to achieve successful fusion with iliac crest corticocancellous bone grafts and Kirschner wire fixation. Implant athroplasty in patients with bone loss is risky as it often furthers joint instability because of bone resorption around the prosthesis. This is a point of caution regarding use of any implant (including large screws) in patients with arthritis mutilans, as osteolysis around the implant may occur.

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“…While Swanson has shown bone build up around MP implants in cases of rheumatoid arthritis, the reverse occurs in patients with arthritis mutilans [10,13].…”

Section: Discussionmentioning

confidence: 99%

Failure of Small Joint Arthrodesis from Resorption Around a Compression Screw in a Patient with Lupus-Associated Arthritis Mutilans: Case Report

Aliu

Netscher

Peltier

2007

Hand (New York, N,Y.)

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“…Outcomes in terms of range of motion vary from 25° to 66°. The rate of fractured prostheses varies from 1.25% in Swanson's own study, to 39% [1,73]. There appears to be agreement that Swanson arthroplasty generally provides pain relief and good cosmetic correction, but that the joints gradually stiffen in conjunction with bone resorption and subsidence of the prosthesis into adjacent bone structures.…”

Section: Silicone Arthroplastymentioning

confidence: 90%

“…For more than 20 years, Swanson arthroplasty has been the predominant technique for arthroplasty in the MCP joints of the fingers (Table 2) [8,11,12,24,32,35,36,45,49,51,73,79]. With the Swanson approach, the implant-a flexible silicone spacer with proximal and distal shafts-replaces the destroyed MCP joint.…”

Section: Silicone Arthroplastymentioning

confidence: 99%

The hand

2000

Acta Orthopaedica Scandinavica

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Submit your article to this journalArticle views: 57 The hand Typical deformities in rheumatoid arthritis include ulnar drift of the fingers, swan-neck and Boutonnière deformity (imbalance and malalignment of the PIP and DIP joints of the fingers), and shoemaker's thumb. These malalignments, along with pain and decreased mobility, may seriously impair hand function.The goal of surgical treatment is to: -achieve pain relief -counteract deterioration -improve function -achieve cosmetic improvement.Soft tissue surgery, eg, synovectomy in joints and tendon sheaths, for joint pain or mobility problems, tendon transfer for deviated fingers or following tendon rupture, and neurolysis to treat compression of peripheral nerves, can often improve hand function and counteract deterioration.If the joints are more or less destroyed by the rheumatic process, arthrodesis may be a suitable treatment in some joints (the MCP joint of the thumb, DIP joints of the fingers), while arthroplasty is the most appropriate surgical approach in other joints (the MCP joints of the fingers).The data in this chapter are based mainly on retrospective clinical and radiological studies of rheumatic patients. AnatomyThe bones and joints of the hand (starting from the wrist) consist of 5 carpometacarpal joints (CMC I-V) between the wrist (carpal bones) and metacarpal bones, 5 metacarpophalangeal joints (MCP I-V) between the metacarpal bones and phalangeal bones, and proximal and distal interphalangeal joints (PIP and DIP joints) between the different phalangeal bones. Mobility in CMC I (saddle joint) is good which, eg, enables the thumb to be positioned in opposition to the fingers. Other CMC joints have little or no mobility; CMC II and III are tight joints. The MCP joints have a mobility of approximately 90° from extended to flexed position, and also have the capacity to deviate to the side so the hand grip can adapt to the shape of an object. The PIP and DIP joints are hinge joints with mobility of approximately 100° (PIP) and 70° (DIP) respectively.

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“…Arthroplasty using silicone implants was introduced by Swanson and has for more than 30 years been the gold standard for endoprosthetic replacement of the MCP-joints [10,22]. The concept is based on a flexible silicone spacer with proximally and distally directed stems (Fig.…”

Section: Silicone Implantsmentioning

confidence: 99%

How I do it—MP joint arthroplasty

Sollerman

2006

International Congress Series

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Flexible implant arthroplasty for arthritic finger joints

Cited by 56 publications

References 0 publications

Failure of Small Joint Arthrodesis from Resorption Around a Compression Screw in a Patient with Lupus-Associated Arthritis Mutilans: Case Report

Failure of Small Joint Arthrodesis from Resorption Around a Compression Screw in a Patient with Lupus-Associated Arthritis Mutilans: Case Report

The hand

How I do it—MP joint arthroplasty

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