Long-term Outcomes of MCP Surface Replacement Arthroplasty in Patients With Rheumatoid Arthritis

Abstract

Background: Surface replacement arthroplasty (SRA) can be used in the treatment of rheumatoid arthritis (RA) affecting the metacarpophalangeal (MCP) joint. The authors of this study sought to investigate the outcomes of MCP SRA in patients with RA. Methods: Retrospective review of medical records and an institutional joint registry were used to gather data on 80 MCP SRAs performed in 27 patients with RA. Data collected included demographics, SRA revisions, reoperations, complications, pain, and MCP arc of motion. Results: The mean postoperative follow-up was 9.5 years (range, 2.1-20.5 years), with all SRAs achieving at least 2 years of follow-up. Thirteen digits (16%) underwent revision arthroplasty, and 29 (36%) required reoperation. The 5-, 10-, 15-, and 20-year rates of survival from implant revision were 95%, 85%, 80%, and 69%, respectively. The 5-, 10-, 15-, and 20-year rates of survival from overall reoperation were 80%, 65%, 55%, and 46%, respectively. Metacarpophalangeal joint arc of motion, grip strength, and pain levels significantly improved following surgery. Conclusions: Metacarpophalangeal SRA can offer benefit to patients with RA for improvement in function and pain. High overall reoperation rates remain concerning; however, most do not involve arthroplasty revision.

Long-term survival of 2997 finger metacarpophalanageal joint arthroplasties from the Norwegian Arthroplasty Register

“…The majority of replacements were performed in women. This is also similar to the findings in several other studies ( Boe et al., 2018 ; Claxton et al., 2022 ; Kimani et al., 2009 ; Notermans et al., 2020 ; Wagner et al., 2019 ). One reason for this is likely that women disproportionately have RA ( Favalli et al., 2019 ).…”

“…Similar to other studies ( Boe et al., 2018 ; Claxton et al., 2022 ; Wagner et al., 2019 ), the age of men and women was similar (61 years) at the time of joint replacement in our study.…”

“…We found that most patients had more than one finger in each hand replaced. Other studies ( Boe et al., 2018 ; Claxton et al., 2022 ; Cook et al., 1999 ; Kimani et al., 2009 ; Notermans et al., 2020 ; Wagner et al., 2019 ) have shown similar results, most probably because patients diagnosed with RA often have both hands affected.…”

“…Other studies ( Boe et al., 2018 ; Cook et al., 1999 ; Wagner et al., 2019 ) also found the great majority of implants in patients with RA or inflammatory arthritis. Claxton et al. (2022) and Notermans et al.…”

“…Finger joint prosthesis, such as for the metacarpophalangeal (MCP) joint, have historically been used most often in patients with inflammatory joint disorders. Although the use of these prostheses is well described, there remains a lack of large studies reporting the long-term survival of MCP joint implants ( Boe et al., 2018 ; Claxton et al., 2022 ; Cook et al., 1999 ; Notermans et al., 2020 ; Wagner et al., 2019 ). There is ongoing discussion about the ideal implant and the longevity of different types ( Escott et al., 2010 ), due to the overall high reoperation rates, even though most surgeries do not involve revision arthroplasties ( Claxton et al., 2022 ).…”