Metacarpophalangeal Arthroplasty & Partial Wrist Fusion
as a Surgical Treatment in Rheumatoid Hand Disease
By Pirjo Honkanen
Tampere University Press
Distributed by Coronet Books Inc.
$82.50 Paper original
The typical manifestations of the rheumatoid hand are ulnar drift of the knuckle joints and palmar subluxation of the wrist joint. The wrist collapse facilitates a progression of metacarpophalangeal (MCP) joint deformities, and thus in operative treatment the wrist joint deformity is corrected before MCP joint surgery. Total arthrodesis of the wrist and silicone arthroplasty of the MCP joints have been the gold standards for long in rheumatoid hand surgery. The main problem of the total fusion is the loss of motion of the wrist joint, and after silicone MCP arthroplasty the breakage of the implants and deterioration of the clinical outcome in long-term follow-up.
The aim of this dissertation was to study the effect of partial radiocarpal arthrodesis on rheumatoid hand alignment, function and pain, and to analyse the biocompatibility and clinical results of a novel bioabsorbable 96L/4D poly-L/D-lactide copolymer (PLDLA) implant, also to compare the outcome of PLDLA implant arthroplasty with that of the conventional silicone Swanson prosthesis.
In partial radiocarpal arthrodesis Study (I) 23 patients and 26 wrists (Larsen II-III) were recruited for a prospective non-randomised study and clinical and radiological evaluation were performed at a mean of 5.8-year follow-up. In Studies II and III 23 consecutive patients (80 joints) undergoing MCP arthroplasty using a novel bioabsorbable PLDLA implant were enrolled, and clinical and radiological evaluation was made at minimum 1-year follow-up and at mean 59 months after surgery, the latter follow-up time exceeding the resorption time of the implant. In a randomised clinical Study IV, the outcome of the PLDLA implant was compared to the outcome of the conventional silicone Swanson prosthesis in 52 patients (53 hands and 175 joints) at a mean follow-up of 2 years. In all studies only patients with an inflammatory arthritis diagnosis were included.
Partial radiocarpal arthrodesis gave good pain relief and subjective patient satisfaction was good, 17 out of 23 patients were totally pain-free and satisfaction was excellent or good in 20 patients. The active range of motion (63°) at final follow-up enables most of the activities of daily living. Correction of the ulnar translocation malalignment was achieved and maintained. No serious adverse events were observed after MCP joint arthroplasty with the novel bioabsorbable PLDLA implant. The clinical results (pain relief, range of motion (ROM), correction of the ulnar deviation and volar subluxation) obtained using PLDLA implants in the non-randomised studies (II-III) were comparable to earlier silicone arthroplasty results, and the clinical outcome of the Study III with the follow-up exceeding the resorption time of the implant did not differ substantially from the outcome of Studies II and IV with follow-up time under the bioabsorbtion time of the implant. In the randomised Study IV improvement in pain relief, ROM, power grip and correction of the ulnar deviation were similar in the PLDLA and Swanson groups. Palmar subluxation improved significantly in both groups, but at follow-up, palmar dislocation was observed more frequently in the PLDLA group (44 joints) than in the Swanson group (10 joints).
Acta Universitatis TamperensisNo. 1698
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