Therapy of rheumatoid destruction of the middle finger metacarpophalangeal joint with a Swanson silastic implant stabilized resection arthroplasty: comparative study of long and intermediate term results with and without implantation of titanium grommets
Schmidt, K.; Witt, K.; Ossowski, A.; Miehlke, R.K.
Zeitschrift für Rheumatologie 56(5): 287-297
1997
ISSN/ISBN: 0340-1855 PMID: 9465382 Document Number: 7926
Resection arthroplasty of the metacarpophangeal joints stabilized by a Swanson-Silastic-spacer is the golden standard in MP-joint destruction in R.A. 57 (Gr. I), 91 (Gr. II), and 102 (Gr. III) arthroplasties of the metacarpophalangeal joint were assessed in three groups of patients 3.5 years (Gr. I), 4.3 years (Gr. II), and 10.1 years (Gr. III), respectively, postoperatively on the average. In patients of group I titanium protectors, called grommets, were used additionally. Nearly all patients reported a marked relief of pain. Ulnar drift was corrected from an average of 22 degrees (Gr. I), 23 degrees (Gr. II), and 34 degrees (Gr. III) preoperatively. to 8 degrees (Gr. I), 7 degrees (Gr. II), and 12 degrees (Gr. III), respectively, postoperatively. Active range of motion remains unchanged with an average of 33 degrees (Gr. I), 38 degrees (Gr. II), and 42 degrees (Gr. III) ROM preoperatively and 42 degrees (Gr. I), 37 degrees (Gr. II), and 36 degrees (Gr. III) ROM, respectively, postoperatively. The average extension deficit had improved from 45 degrees (Gr. I), 32 degrees (Gr. II), and 33 degrees (Gr. III) at surgery to 18 degrees (Gr. I), 11 degrees (Gr. II), and 11 degrees (Gr. III), respectively, at the time of follow-up. Functional improvement of the hand was found in the medium term in 82% and in the longterm in 75% of the patients. The radiographical findings showed surrounding osteolysis in 45.7% (Gr. I), 63.5% (Gr. II), and 89.4% (Gr. III) of the implants and 0% (Gr. I), 16.5% (Gr. II), and 26.9% (Gr. III) broken spacers. From the medium to the longterm run there is an increase in radiographical deterioration. The additional use of titanium grommets in MP-joint arthroplasty seems to reduce reactive osteolysis and protects Swanson Silastic-spacers from breakage without substantial influence on the clinical outcome.
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