Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis

Only a few of the large number of implants developed during the last decades for replacement of the metacarpophalangeal (MCP) joint have proven to be reliable. The rates of loosening and mechanical failure of almost all types of constrained prostheses are so high that their use cannot be recommended at present. For more than 40 years silicone arthroplasty according to Swanson has been regarded as the gold standard in the prosthetic replacement of the MCP joint. In long-term studies this device provided good pain relief and a lasting correction of preoperative ulnar deviation. The degree of patient satisfaction continues to be high after more than 10 years. With the NeuFlex spacer, a modification of the original Swanson implant, a better range of motion and a reduction of wear-related problems is expected. In this study the results of 130 NeuFlex spacers after a mean time of 3.6 years were examined and 82% of the patients were completely pain free. The mobility of the joints improved from 40 degrees preoperatively to 54 degrees after 3.6 years. Radiologically periprosthetic erosions or osteolyses were seen in approximately 15% of implants. A minimal sinking of the stems developed in 24%, a massive one in 6% and 13% of the spacers were broken. Thus the use of the NeuFlex implant resulted in a better range of motion compared to the Swanson spacer, but the problem of radiological appearance remained unchanged. For unlinked prostheses sufficient soft tissue stability is mandatory as well as wear-resistant surface materials. The pyrocarbon prosthesis according to Beckenbaugh is the only implant for which long-term results are available. In a prospective study we evaluated 28 Ascension pyrocarbon prostheses with a mean follow-up of 4 years. Stability was not found to be a problem. Subjective results were satisfactory, the range of motion remained unchanged, however 46% of prosthesis stems exhibited radiolucent seams, 7 prostheses (25%) were rated as loose and 5 of those had to be replaced by a silicone implant. Use of the implant was abandoned, as it was unreliable regarding bony fixation. There are promising concepts in some new prostheses but independent data are still lacking.

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“…In den Folgejahren ist jedoch zumeist ein teilweiser, aber praktisch nie ein völliger Korrekturverlust zu beobachten [19,20,27,44].…”

Section: Flexible Implantateunclassified

“…Elementare Tätigkeiten wie die Nahrungsaufnahme, das Schreiben oder das Knöpfen von KleiAbb. 2 [2,20,25,41,50]. Im Gegensatz zu einer gekoppelten Prothese bleibt jedoch die Fraktur des Implantats häufig ohne Auswirkungen und wird vom Patienten in der Regel nicht registriert.…”

Section: Flexible Implantateunclassified

Endoprothetik des Fingergrundgelenks

Hilker

Miehlke²,

Schmidt

2007

Z. Rheumatol.

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“…The most commonly used method for MCP joint arthroplasty is the application of a Swanson silicone-elastomer implant [1]. In spite of initial improvement, long-term complications, such as mechanical failures, loosening, and adverse tissue inflammatory reactions, have led to a search for better methods [2,3]. On the other hand, there is also radiographic evidence of the loosening of polyethylene and metal total joint MCP prostheses [4], and there have been difficulties in rebalancing the soft tissues in patients with rheumatoid arthritis [5].…”

Section: Introductionmentioning

confidence: 99%

Pyrolytic carbon MCP arthroplasty: a report of seven prostheses implanted in two patients

Kujala

Bongiorno

Kaarela

et al. 2006

J Orthopaed Traumatol

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Rheumatoid arthritis most commonly affects the metacarpophalangeal (MCP) joints of the hand. Pyrolytic carbon MCP arthroplasty has lately provided a new alternative in the treatment of these patients, but reports in the literature are still few. Here, we report the mid-term results of seven such prostheses implanted in two elderly patients with rheumatoid arthritis. Pyrolytic carbon MCP arthroplasty was performed on three MCP joints in one patient and on four MCP joints in another patient. A specific postoperative mobilization protocol was applied. Range of motion, grip strength, and pinch strength were recorded, and radiographs were taken at three, six, and ten months postoperatively. Ten months after the operation, the operated joints were pain-free, and grip and pinch strengths had improved. On average, the passive range of motion had improved and the active range of motion had remained about the same. The joints were clinically stable. No adverse remodeling or bone resorption was observed radiographically. Ulnar deviation recurred in one of the two cases. These results suggest pyrolytic carbon MCP arthroplasty to be a noteworthy alternative in the treatment of MCP joints affected by rheumatoid arthritis. Early treatment, before the development of severe soft tissue destruction, seems to yield better results.

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“…Possible explanations, but not limited to are: (i) low tensile strength, [3,4] (ii) inadequate bone build-up around the implants, (iii) loosening at the bone-implant interface induced by damaging impact of reactive oxygen species (superoxide: O À 2 and peroxynitrate: OONO À ) produced by activated microphages, (iv) dislocation of the implant and infection and recurrent deformation. [14] In a biomedical application, success is achieved when the different mechanisms associated with the failure are attended. Thus, the continued challenge for materials in contact with the bone is design of high strength materials with the ability to modulate cell-substrate interactions from the view point of enhancing osseointegration (bone regeneration) and long term stability.…”

mentioning

confidence: 99%

Enhanced Fibroblasts Functions in a New Family of Hierarchically Organized Nanohybrid Elastomers

2011

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Fibroblasts functions in a new family of nanohybrid network elastomers with high strength‐at‐break involving pressure‐induced curing and short chain cross‐links of inorganic nanostructures have been investigated. The concept of chemical design and synthesis involves covalently linking nanometer‐sized titania with a bi‐functional agent, acrylic acid, which has a carboxylic group to coordinate with titania and a vinyl group to form short chain cross‐links as an integral part of the silicone network structure elastomer. Interestingly, the cell–substrate interactions in the hybrid network structure elastomer are significantly different from those observed in stand alone silicone. The origin of intriguing differences in cell–substrate interactions in terms of cell attachment, viability, and proliferation and assessment of proteins actin, vinculin, and fibronectin are addressed and attributed to physico‐chemical properties (topography and hydrophilicity) and to the presence of nanocrystalline titania. The end outcome of the study is a new family of soft tissue implants with desired (enhanced cell functions) and bulk properties (long term stability–high strength‐at‐break). The integration of cellular and molecular biology with material science and engineering described here provides an insight into the ability to modulate cellular and molecular reactions in promoting osteoinductive signaling of surface adherent cells, in the present case, fibroblasts for soft tissue reconstruction.

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Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis

Cited by 180 publications

References 16 publications

Endoprothetik des Fingergrundgelenks

Endoprothetik des Fingergrundgelenks

Pyrolytic carbon MCP arthroplasty: a report of seven prostheses implanted in two patients

Enhanced Fibroblasts Functions in a New Family of Hierarchically Organized Nanohybrid Elastomers

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