Results of revision metacarpophalangeal joint surgery in rheumatoid patients following previous silicone arthroplasty.

PURPOSE: Primary silicone metacarpophalangeal (MCP) joint arthroplasties have good results that deteriorate with time. The purpose of this study was to assess indications, patient satisfaction, and clinical and radiographic results following revision surgery in rheumatoid patients who had previously undergone silicone MCP arthroplasty.

METHODS

Twenty hands in 18 patients (62 implants) had revision silicone MCP arthroplasties between 1986 and 2005 and had a greater than 1-year follow-up period (mean 5 y). A retrospective chart review was performed to collect preoperative and intraoperative data. Patients were then re-examined and administered a questionnaire addressing subjective outcome and satisfaction.

RESULTS

Intraoperatively, 76% of the implants were fractured. Thirteen of 17 synovial biopsies revealed giant cell foreign body reaction. Preoperatively, the average arc of motion was from 16 degrees to 50 degrees , and ulnar drift was 24 degrees . Postoperatively, the average arc of motion was from 20 degrees to 54 degrees , and ulnar drift was 13 degrees . X-rays of 14 hands revealed that 15 of 44 revised implants had fractured. Sixteen patients (18 hands) were available to complete questionnaires. Twelve patients (14 hands) were satisfied and 3 were dissatisfied. Five of 16 patients would not have the revision again. These patients had worse average postoperative ulnar drift (30 degrees vs 9 degrees ) than the other 11 patients. All patients except one who had preoperative pain had at least moderate pain relief, and of the 6 patients who had revision surgery because of pain, 5 were satisfied.

CONCLUSIONS

Revision silicone arthroplasty provides excellent pain relief, and the majority of patients were pleased with their results. Objective results, however, were generally poor. Soft tissue reconstruction is more difficult to achieve than the primary procedure, as evidenced by minimal improvement in ulnar drift, a high rate of implant fracture, and no change in arc of motion.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.