Silicone Rubber Implants for Replacement of Arthritic or Destroyed Joints in the Hand

Swanson, Alfred B.; Peltier, Leonard F.

doi:10.1097/00003086-199709000-00002

Cited by 61 publications

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“…At the time of implantation, synovectomy and soft-tissue balancing procedures are often performed to increase lateral joint stability or enhance the biomechanical advantage of the tendons around the MCP joint. These procedures include release of the tendons of abductor digiti minimi and flexor digiti minimi, 3 reconstruction of the radial collateral ligaments, 4 centralization of the extensor digitorum tendon, and transfer of the intrinsic insertions so that they provide radial pull. 5 Six comparative studies evaluated the efficacy of various soft-tissue rebalancing procedures.…”

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confidence: 99%

Postoperative therapy after metacarpophalangeal arthroplasty

Massy‐Westropp

Krishnan

2003

Journal of Hand Therapy

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A literature review was conducted to determine the most effective postoperative therapy regimens for metacarpophalangeal (MCP) arthroplasty. The main difference between the regimens was the use of passive MCP extension over active extension and splinting in MCP flexion over splinting in extension. One study did not find continuous passive motion to be significantly beneficial for gaining hand strength or MCP motion. No study evaluated the efficacy or suitability of a particular regimen for specific implants or surgical procedures. J HAND THER. 2003;16:311-314.

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confidence: 99%

Postoperative therapy after metacarpophalangeal arthroplasty

Massy‐Westropp

Krishnan

2003

Journal of Hand Therapy

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“…A wide variety of operations has been advocated including arthrodesis, 2 excision arthroplasty, 3,4 interposition arthroplasty with silastic, 5 interposition arthroplasty with soft tissue, 6 trapeziectomy with a stabilising tendon sling 7 and total joint replacement. 8 Osteotomy of the first metacarpal is a simple technique which has been largely overlooked.…”

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confidence: 99%

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

Hobby

Lyall

Meggitt

1998

The Journal of Bone and Joint Surgery. British volume

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We report a long-term follow-up of abduction-extension osteotomy of the first metacarpal, performed for painful trapeziometacarpal osteoarthritis. Of a consecutive series of 50 operations, 41 thumbs (82%) were reviewed at a mean follow-up of 6.8 years. Good or excellent pain relief was achieved in 80%, and 93% considered that surgery had improved hand function, while 82% had normal grip and pinch strength, with restoration of thumb abduction. Trapeziometacarpal osteoarthritis is associated with degeneration of the palmar beak ligament 10 and articular degeneration starts on the joint surfaces adjacent to it. The cartilage of the dorsoradial joint surface is spared until late in the disease process. 10 A recent cadaver study has shown that extension osteotomy of the first metacarpal shifts the area of joint contact from the worn palmar cartilage to the normal dorsal surface. 11 We describe our experience of osteotomy in a large series of patients over a period of 12 years. Patients and MethodsWe carried out 50 operations in 42 patients; 41 thumbs (82%) in 33 patients were available for review at a mean of 6.8 years (2 to 12) from operation. The average age at operation was 57 years (20 to 73). Nine of the operations were in men and 32 in women, and the dominant hand was involved in 20 patients. Nine patients were lost to followup. Three had died, one had moved and could not be contacted, and three very elderly patients could not be traced. Another elderly man was too confused to co-operate. One patient was contacted by telephone but did not wish to be reviewed. When last seen she had complete relief of pain, full abduction and a strong grip. The patients were reviewed by a surgeon who had not been involved in the operation. Pain and hand function were assessed by the patient, using a self-administered questionnaire. Grip strength was measured with a Jamar dynamometer (Asimov Engineering Company, Los Angeles, California), and pulp to pulp (pinch) and lateral pinch (key-grip) with a B & L hydraulic pinch meter (B&L Engineering, Santa Fe Springs, California). The mean of three readings was compared with normal ranges matched for age and sex. 12 The range of movement and maximum abduction were measured clinically with a goniometer. Thumb opposition and the ability to flatten the palm were assessed and recorded. Indications for operation. Surgery was carried out when pain which interfered with everyday activities had not responded to conservative treatment with a splint, nonsteroidal anti-inflammatory drugs or injection with lignocaine and hydrocortisone. Osteotomy was only considered for mild and moderate degenerative changes confined to the trapeziometacarpal joint, scaphotrapezial wear being a contraindication. The preoperative radiographs were graded as described by Eaton and Littler 13 : grade 1, no radiological changes; grade 2, osteophytes or intra-articular fragments of <2 mm with no narrowing of

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“…A MCPJ fusion should be avoided as a primary surgical procedure, and it is only considered when other surgical procedures have been failed [2,[11][12][13][14]. Despite the well-known high complication rate (wear-related synovitis and osteolysis, implant loosening and/or breakage), the silicone rubber implants, introduced in 1968 by Swanson [15] and its recent further development NeuFlex, introduced in 1998, are recommended unchanged for low-demand patients with RA ( Figure 1A-B) [4,16,17], and MCPJ resection-interposition arthroplasties with the use of autologous soft tissue structures can be another option for these patients [11,[18][19][20].…”

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confidence: 99%

A 10-Year Follow-Up of Uncemented Constrained Metacarpophalangeal Joint Arthroplasties Using the RM Prosthesis in a Patient with Rheumatoid Arthritis.

Schmidt¹

2017

JRAD

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A 72-year-old male with high-demand activities of daily living presented with rheumatoid arthritis mostly affected finger joints of his right hand. Radiographically, there was severe destruction with luxation of metacarpophalangeal joints (MCPJs) II-V. The constrained RM prostheses were inserted into the MCPJs II-V typically in the uncemented manner, and the course was primarily complicated due to periprosthetic fracture of the metacarpal IV intraoperatively, that was treated with immobilization in a plaster splint for 6 weeks. After that, the course was uncomplicated. Eight years after primary surgery, the patient reported increasing pain with loss of function isolated in his MCPJ IV since 6 months; all other finger joints did not reveal any clinically relevant symptoms. Radiographically, distinctive osteolyses with cortical thinning around all components of the 4 RM prostheses were seen, and the hinge joint of implant in MCPJ IV was broken. A total exchange arthroplasty of the MCPJ IV using the unconstrained MCPJ resurfacing SR TM MCP implant with cementation of both components was performed. At the 10-year follow-up, that includes a 2-year followup after MCPJ IV exchange arthroplasty, there was unchanged correct positioning of all MCPJ implants; and despite distinctive radiographic loosening and subsidence of the 3 other RM prostheses, the patient is able to perform his high-demand activities of daily living.

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Silicone Rubber Implants for Replacement of Arthritic or Destroyed Joints in the Hand

Cited by 61 publications

References 0 publications

Postoperative therapy after metacarpophalangeal arthroplasty

Postoperative therapy after metacarpophalangeal arthroplasty

First metacarpal osteotomy for trapeziometacarpal osteoarthritis

A 10-Year Follow-Up of Uncemented Constrained Metacarpophalangeal Joint Arthroplasties Using the RM Prosthesis in a Patient with Rheumatoid Arthritis.

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