Silicone Synovitis

1994 ◽  
Vol 19 (4) ◽  
pp. 479-484 ◽  
Author(s):  
M. LANZETTA ◽  
T. J. HERBERT ◽  
W. B. CONOLLY
Keyword(s):  
Rheumatoid Arthritis ◽  
Effective Treatment ◽  
Revision Surgery ◽  
Joint Arthroplasty ◽  
Silicone Implant ◽  
Joint Disease ◽  
Silicone Implants ◽  
True Incidence ◽  
Radiological Changes

Silicone implant arthroplasty is, arguably, the most effective treatment for the majority of patients with symptomatic arthritis in the hand and wrist. In 1985 the problem of silicone synovitis was first brought to our attention. Since that time there have been numerous reports on this condition leading to a worldwide trend against the use of silicone implants. However, the true incidence and effects of silicone synovitis have not been clearly defined. For this reason, we have undertaken a survey of all patients who have undergone silicone implant arthroplasty in the wrist and hand in our Unit between 1975 and 1990. Patients with rheumatoid arthritis and those undergoing MP or IP joint arthroplasty were excluded. Of the 289 implant arthroplasties remaining, we have been able to review personally 229 implants with a mean follow-up of 3.8 years (range 1–15). Although 40% of cases showed significant radiological changes, only 11 patients (4.8%) developed symptoms requiring treatment. Of these, two were managed conservatively whilst the rest underwent revision surgery, all with entirely satisfactory results. We conclude that silicone implant arthroplasty remains the treatment of choice for patients with painful joint disease in the hand and wrist.

Use of Titanium Grommets in Silicone Implant Arthroplasty of the Hallux Metatarsophalangeal Joint

1996 ◽  
Vol 17 (3) ◽  
pp. 145-151 ◽  
Author(s):  
E. James Sebold ◽  
Andrea Cracchiolo
Keyword(s):  
Rheumatoid Arthritis ◽  
Metatarsophalangeal Joint ◽  
Degenerative Joint Disease ◽  
Silicone Implant ◽  
Joint Disease ◽  
Silicone Implants ◽  
Postoperative Complaints ◽  
Lost To Follow Up ◽  
Metatarsophalangeal Joints

Double-stem silicone implants protected by titanium grommets were placed in the hallux metatarsophalangeal joints of 32 patients (47 feet). All patients had a painful destroyed joint and most were women. Three patients (six feet) were lost to follow-up. Nineteen patients had a diagnosis of rheumatoid arthritis (25 feet) and 10 had degenerative joint disease (16 feet). The average age for the group was 57 years and the average follow-up was 51 months (range, 34–76 months). Twenty patients (30 feet) were completely satisfied with their result. Eight patients (10 feet), all with rheumatoid arthritis, had some minor postoperative complaints, usually involving the lateral toes. Two patients (three feet) in this group had no pain, but would have preferred more hallux motion. One patient with rheumatoid arthritis (one foot) had a poor result due to implant removal for deep sepsis. Radiographic analysis of these patients showed no evidence of implant fracture and the implant composite appeared to be well tolerated by the surrounding bone in which it was placed. When compared with another, similar group of patients in whom grommets were not used, this implant appeared to be much more stable, as there was significantly less evidence of radiolucency seen around those implants protected by the grommets. It appears that the titanium grommets may protect the silicone implant and may help provide a longer life for the silicone implant.

REVISION METACARPOPHALANGEAL JOINT REPLACEMENT 30 YEARS AFTER PRIMARY SWANSON FLEXIBLE SILICONE IMPLANT ARTHROPLASTY IN A RHEUMATOID PATIENT: A CASE REPORT

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 25-29 ◽  
Author(s):  
Katsumitsu Arai ◽  
Hajime Ishikawa ◽  
Takehiro Murai ◽  
Junichi Fujisawa ◽  
Naoto Endo
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Joint Replacement ◽  
Revision Surgery ◽  
Metacarpophalangeal Joint ◽  
Joint Arthroplasty ◽  
Implant Removal ◽  
Silicone Implant ◽  
Rheumatoid Patient ◽  
Swanson Implant

We report a case of a patient with rheumatoid arthritis undergoing revision surgery 30 years after primary metacarpophalangeal joint arthroplasty using a Swanson implant. Removal and replacement of the implant were successfully performed, and the patient was satisfied with the revision surgery.

The Effect of the Additional Use of Grommets in Silicone Implant Arthroplasty of the Metacarpophalangeal Joints

1999 ◽  
Vol 24 (5) ◽  
pp. 561-564 ◽  
Author(s):  
K. SCHMIDT ◽  
R. WILLBURGER ◽  
A. OSSOWSKI ◽  
R. K. MIEHLKE
Keyword(s):  
Rheumatoid Arthritis ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Metacarpophalangeal Joint ◽  
Joint Arthroplasty ◽  
Silicone Implant ◽  
Active Movement ◽  
Ulnar Deviation ◽  
Metacarpophalangeal Joints

After silicone arthroplasty of the metacarpophalangeal (MP) joint there is increasing osteolysis, subsidence and fracture of the implants in the longer postoperative term. In 44 patients with rheumatoid arthritis (54 hands) 151 arthroplasties of the metacarpophalangeal joint were assessed at a mean of 3.9 years postoperatively. In 57 arthroplasties titanium protectors (grommets) were used. There were no significant differences in the clinical outcomes with respect to swelling, correction of ulnar deviation, range of active movement and grip strength. The additional use of grommets in MP joint arthroplasty slightly reduced reactive osteolysis, protected the spacers from breakage and slightly reduced the amount of pain with only a few additional complications in the midterm follow-up.

Proximal interphalangeal joint arthroplasty with silicone implants (NeuFlex) by a lateral approach: a series of 51 cases

2011 ◽  
Vol 37 (1) ◽  
pp. 50-55 ◽  
Author(s):  
M. Merle ◽  
F. Villani ◽  
B. Lallemand ◽  
L. Vaienti
Keyword(s):  
Lateral Approach ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Silicone Implants ◽  
Lateral Stability ◽  
Degenerative Osteoarthritis ◽  
The Mean ◽  
Quick Dash

The aim of this study is to assess outcomes of a lateral surgical approach for proximal interphalangeal joint arthroplasty with NeuFlex® silicone implants for primary degenerative osteoarthritis. We reviewed 51 arthroplasties performed on 43 patients. The mean follow up period was 36 months (range 18–42). The average preoperative range of motion (ROM) was 38°. The average postoperative ROM was 63°. In 21/51 (41%) cases, there was an average axial deviation of 17° (range 10–30°). VAS and Quick DASH scores improved. In 5/51 (10%) cases, further surgery was required. Our lateral approach seems to be effective and minimally invasive, providing adequate exposure. Contralateral incision and contralateral ligament reinforcement should be performed, whenever necessary, to improve lateral stability.

Bioreconstructive Poly-L/D-Lactide Implant Compared With Swanson Prosthesis in Metacarpophalangeal Joint Arthroplasty in Rheumatoid Patients: a Randomized Clinical Trial

2010 ◽  
Vol 35 (9) ◽  
pp. 746-753 ◽  
Author(s):  
P.B. Honkanen ◽  
R. Thonen ◽  
E.T. Skyttä ◽  
M. Ikävalko ◽  
M.U.K. Lehto ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Study ◽  
Randomized Clinical Trial ◽  
Joint Destruction ◽  
Metacarpophalangeal Joint ◽  
Joint Arthroplasty ◽  
Silicone Implant ◽  
Clinical Assessments ◽  
Randomized Clinical Study

It was hypothesized that the bioresorbable interposition implant might offer a viable alternative to conventional silicone implant arthroplasty in rheumatoid metacarpophalangeal joint destruction. A randomized clinical study was performed to compare a stemless poly-L/D-lactide copolymer 96: 4 (PLDLA) implant with the Swanson silicone implant. Results in 52 patients (53 hands and 175 joints) at a mean follow-up of 2 years (minimum 1 year) showed that the improvement in clinical assessments was comparable in both groups, except for better maintenance of palmar alignment in the Swanson group. The lack of implant fractures and intramedullary osteolysis were advantages of the PLDLA implant. The bioresorbable PLDLA interposition implant may offer an alternative tool for tailored reconstruction of rheumatoid metacarpophalangeal joints.

Functional Outcome Following Salvage of Failed Trapeziometacarpal Joint Arthroplasty

2002 ◽  
Vol 27 (1) ◽  
pp. 96-100 ◽  
Author(s):  
K. J. RENFREE ◽  
P. C. DELL
Keyword(s):  
Pain Relief ◽  
Functional Outcome ◽  
Revision Surgery ◽  
Complication Rate ◽  
Joint Arthroplasty ◽  
Pinch Strength ◽  
Subjective Outcome ◽  
Trapeziometacarpal Joint ◽  
Improved Function

The outcomes in 12 patients who underwent revision surgery for a failed trapeziometacarpal joint arthroplasty were assessed. Multiple procedures were common (an average of 4.5 per patient), and associated with an overall complication rate of 27%. However, after an average follow-up of 5 years, nine of the 12 patients reported improved function and ability to complete normal daily tasks. Most patients were satisfied with their level of pain relief, their grip and pinch strength, and their overall final result. The subjective outcome was less satisfactory in those involved in workers’ compensation litigation. All seven attempted scaphoid–thumb metacarpal fusions failed.

Removal and successful re-implantation of a customized interpositional knee device following an early postoperative infection: A case report

Open Medicine ◽  
2010 ◽  
Vol 5 (4) ◽  
pp. 442-446 ◽  
Author(s):  
Franz Koeck ◽  
Bjoern Rath ◽  
Hans-Robert Springorum ◽  
Markus Tingart ◽  
Joachim Grifka ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Revision Surgery ◽  
Rare Case ◽  
Postoperative Infection ◽  
Clinical Results ◽  
Total Knee Arthroplasties ◽  
First Case ◽  
Alternative Treatment Option ◽  
Total Knee

AbstractWe report the first case of early postoperative infection after a medial hemiarthroplasty of the knee with a customized ConforMIS iForma™ interpositional device. The infection was treated successfully by revision surgery with implant removal and antibiotic therapy. Despite the additional diagnosis of rheumatoid arthritis that did not affect the treated knee, the preservation of bony and ligamentous structures enabled a successful re-implantation of another iForma™ implant 9 months later with good clinical results at follow-up examination 1 year postoperatively. This is very much in contrast to the extensive and complex revision surgery, with significant bone loss, in patients with infected unicompartmental or total knee arthroplasties. The iForma™ device may be an alternative treatment option in early and moderate unicompartmental arthritis of the knee, with easy revision with the same type of implant in the rare case of infection.

Flexor Tenosynovectomy and Tenolysis in Longstanding Rheumatoid Arthritis

1996 ◽  
Vol 21 (4) ◽  
pp. 538-543 ◽  
Author(s):  
A. R. TOLAT ◽  
J. K. STANLEY ◽  
R. A. EVANS
Keyword(s):  
Rheumatoid Arthritis ◽  
Joint Disease ◽  
Surgical Indications ◽  
Active Motion ◽  
Total Active Motion ◽  
Tendon Ruptures ◽  
Finger Motion ◽  
Digital Surgery ◽  
Low Rate

A total of 43 patients (49 hands; 424 flexor tendons), who had rheumatoid arthritis of more than 15 years duration at the time of surgery, were clinically assessed at a mean follow-up of 5.7 years (range, 1.2–12 years). Pain and inability to flex actively despite a good passive range of motion were the main surgical indications. The results suggest that the patients had excellent sustained pain relief (mean score=0.9) and were highly satisfied with the outcome of the procedure (mean score = 2.2). 81% had adequate pulp-to-pulp and key pinch. Range of finger motion (total active motion, TAM) was excellent to good in 45% and fair in 22%. Thirty-three per cent were graded as poor and these were found to be multifactorial in origin, with associated significant joint disease, preoperative tendon ruptures, extensive digital surgery, readhesions and combinations of operative procedures which adversely affect the rehabilitation programme. Flexor tenosynovectomy with tenolysis is a useful procedure with a low rate of recurrence.

NT-proBNP predicts mortality in patients with rheumatoid arthritis: results from 10-year follow-up of the EURIDISS study

2010 ◽  
Vol 69 (11) ◽  
pp. 1946-1950 ◽  
Author(s):  
Sella Provan ◽  
Kristin Angel ◽  
Anne Grete Semb ◽  
Dan Atar ◽  
Tore K Kvien
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity Score ◽  
Health Assessment ◽  
Joint Disease ◽  
Serum Samples ◽  
Prediction Of Mortality ◽  
Incremental Information ◽  
Univariate Analyses ◽  
Assessment Questionnaire

ObjectivesPatients with rheumatoid arthritis (RA) have a higher mortality than the general population, and this increased mortality is related to demographic and disease variables. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor of mortality both in general and patient populations, but has not been shown to predict mortality in patients with RA. This study examines whether NT-proBNP can further improve the prediction of mortality in RA.Methods182 patients with RA of 5–9 years disease duration were comprehensively examined in 1997. Serum samples were frozen and later batch analysed for NT-proBNP levels and other biomarkers. Adjusted univariate and logistic regression analyses were performed with death within the 10-year follow-up period as the dependent variable. Significant predictors were also examined as dichotomised variables.ResultsMortality was predicted in univariate analyses by the following variables: age, sex, homozygosity for HLA-DRB1 shared epitope alleles, Health Assessment Questionnaire, 28-joint Disease Activity Score (DAS28) and NT-proBNP. A multivariate model with age, sex, DAS28 and NT-proBNP as independent variables showed the greatest discrimination.ConclusionNT-proBNP provided incremental information in the prediction of mortality in this cohort of patients with RA.

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