Reconstruction of finger joints using autologous rib perichondrium – an observational study at a single Centre with a median follow-up of 37 years

Abstract

Background: Gratifying long-term results are difficult to achieve when reconstructing osteoarthritic finger joints. Implant surgery is the most commonly used method to restore function and dexterity. However, all types of implant have disadvantages and may be a less favorable option in some cases, especially in young patients with a long expected lifetime and high demands on manual load. Implant related complications as loosening, instability, subsidence and stiffness are the main concerns. In this context, joint reconstruction using rib perichondrium might be a reasonable alternative in selected cases. The aim of the study was to evaluate the long-term results of finger joint reconstruction using rib perichondrial transplantation. Methods: The study group (n = 11) consisted of eight individuals reconstructed in the proximal interphalangeal (PIP) joints and three reconstructed in the metacarpophalangeal (MCP) joints during 1974-1981. All patients were evaluated at clinical visits (median: 37 years after perichondrial transplantation, range: 34-41 years) using radiographs, disability in arm-shoulder-hand (DASH) score, Visual Analog Scale (VAS), range-of-motion (ROM) and manual strength (JAMAR). Results: None of the 11 patients had undergone additional surgery. All of the PIP-joints (n = 8) were almost painfree at activity (VAS 0,6) (range 0-4), had an average range-of-motion of 41 degrees (range 5-80) and a mean DASH-score of 8,3 (range 1-51). The mean strength was 41 kg compared to 44 kg in the contralateral hand (93%). The three MCP joints were almost pain-free at activity (VAS 0,7), (range 0-1). The ROM was on average 80 degrees (range 70-90) and the mean DASH-score was 2 (range 1-3). The mean strength was 43 kg compared to 53 kg in the contralateral hand (81%). Conclusions: Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. Additional studies are needed to evaluate long-term results in comparison to modern implants and to better describe the factors that determine the outcome of these procedures.

Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26 years

“…4 and video 1). These results are in accordance to the recently reported longterm results (mean 37 years) after perichondrial transplantation to the PIP and MCP joints [16].…”

“…The results were graded as good if pain was absent, swelling occurred only occasionally, and the range of motion was satisfactory, and such results were found in about half of the MCP and the PIP joints. Muder et al recently reported clinical outcome in 11 patients 37 years (range 34-41) after perichondrial transplantation to the PIP (n = 8) and MCP joint (n = 3) [16]. The ROM in the PIP group (n = 8) was on average 41 degrees (range 5-80).…”

“…We designed a comparative retrospective cohort study of patients operated with either perichondrium transplantations or two-component SR implants to the MCP or PIP joints performed at Uppsala University Hospital between 1981 and 2018. The starting point for the time frame, 1981, was chosen in direct continuity to the study cohort from Muder et al reported earlier this year from our institution [16]. Moreover, since SR implants are relatively new on the market, we wanted a timeframe when both techniques were in use.…”

“…Moreover, since SR implants are relatively new on the market, we wanted a timeframe when both techniques were in use. We have recently reported the long-term outcome after perichondrium transplantation performed before 1981 [16]. None of the cases from before 1981 are included in the present study.…”

“…Most reports on joint reconstructions in the hand with perichondrium are historical and consist of limited case series on few patients ( n = 17—26) mostly reporting short-term results [ 12 , 13 , 15 ]. Recently, long-term results after perichondrial transplantation to finger joints were reported [ 16 ]. The follow-up time was very long (mean 37 years) and the results were gratifying in most cases.…”