Outcomes of Surface Replacement Arthroplasty in Metacarpophalangeal Joints Affected by Noninflammatory Arthritis

Background The purpose of this study was to investigate the outcomes of surface replacement arthroplasty (SRA) for noninflammatory arthritis of the metacarpophalangeal (MCP) joint. Methods Records from 20 SRAs performed between 1995 and 2017 in 17 patients with noninflammatory arthritis affecting the MCP joint were retrospectively reviewed. The mean follow up was 6.6 years. Results Three arthroplasties (15%) underwent 4 revision operations. The 2-, 5-, 10-, and 15-year rates of survival from surface replacement implant revision were 90%, 90%, 79%, and 79%, respectively. Major complications occurring in revised joints included arthrodesis (n = 1) and amputation (n = 1). The overall reoperation rate was 35%. The 2-, 5-, 10-, and 15-year rates of overall reoperation-free survival were 75%, 69%, 60%, and 60%, respectively. Conclusions Pain ratings and MCP arc of motion significantly improved following arthroplasty. Metacarpophalangeal SRA for noninflammatory arthritis can improve arc of motion and pain. Revision is uncommon; however, 1 in 3 joints requires reoperation.

A csípőprotézis-választás nehézségeinek és felelősségének bemutatása egy eset kapcsán

Összefoglaló. A felszínpótló, fém a fémen csípőízületi protézisek reneszánszukat élték a 2000-es években. Elsősorban fiatal, aktív betegek esetében javasolták használni a remélt elméleti előnyök, mint a combfej csontállományának megőrzése, a csípőízület biomechanikájának fenntartása, a luxatio kockázatának csökkentése, a polietilén törmelékek és kopástermékek hiánya miatt. Bemutatunk egy beteget, akinél 19 éves korában kétszeri vesetranszplantációt követő, hosszan tartó szteroidkezelés következtében kialakult kétoldali combfejnekrózis miatt került sor felszínpótló, fém a fémen csípőprotézis beültetésére. A harmadik posztoperatív évtől mindkét csípőt érintő, fokozatosan súlyosbodó fájdalom, pszichés tünetek, valamint ismételt veseelégtelenség alakult ki. A tünetek hátterében kifejezetten magas Co-Cr szérumszintet, a csípőízület környezetében pszeudotumor-kialakulást, kiterjedt acetabularis cystákat, a combnyakak jelentős elvékonyodását találtuk, mely jobb oldalon periprotetikus combnyaktörést okozott. A revíziós műtétek során talált kiterjedt szöveti metallosis eltávolítását követően a felszínpótló protéziseket cement nélküli kerámia–kerámia totális protézisekre cseréltük. A revíziókat követően a lokális és pszichés tünetek megszűntek, a szérum Co-Cr szintje normalizálódott, ami lehetővé tette a harmadik vesetranszplantáció elvégzését is. Páciensünk csípőrevíziókat követő gyors javulása közvetett bizonyítékként szolgál a Co-Cr ionok negatív szerepére mind a helyi, mind a szisztémás szöveti reakciókban, így a transzplantált vese károsodásában. Esetünk tanulságai, hogy szervtranszplantációt követően kerülni kell a fém a fémen protézisek használatát, valamint hogy nem elég a csípőízületi protézis indikációjának felállítása és a legmodernebbnek tartott protézis használata. Különös gonddal és elmélyülten kell elemezni a beteg járulékos körülményeit, gyógyszerelését, társbetegségeit is ahhoz, hogy a legmegfelelőbb típusú protézist tudjuk kiválasztani, ami nem megkerülhető felelőssége az ortopéd sebészeknek. Orv Hetil. 2021; 162(20): 800–805. Summary. The surface replacement, metal on metal hip prostheses, experienced a renaissance in the 2000s. It has been recommended for use primarily in young, active patients due to expected theoretical benefits such as preserving femoral bone stock, maintaining hip joint biomechanics, reducing the risk of dislocation, and lacking polyethylene debris abrasion products. We present a patient who had resurfacing prosthesis because of bilateral femoral head necrosis due to long-term steroid treatment following double kidney transplantation at the age of 19. In the third postoperative year, progressive pain in both hips, psychiatric symptoms, and recurrent renal failure developed. We found extremely high serum Co-Cr levels, pseudotumor formation of the hip joint, extensive acetabular cysts, and significant thinning of the femoral neck, followed by a periprosthetic femoral neck fracture on one side. After removing the extensive tissue metallosis found during the revision surgeries, the surface replacement prostheses were replaced with cementless ceramic–ceramic total prostheses. Following the revisions, local and psychiatric symptoms resolved, and serum Co-Cr levels normalized, allowing a third kidney transplant to be performed. The rapid improvement of our patient after prosthesis revisions serves as indirect evidence for the negative role of Co-Cr ions in both local and systemic tissue reactions, including damage to the transplanted kidney. Our case report shows that the use of metal on metal prostheses after organ transplantation should be avoided and simply setting up an indication for hip prosthesis and use the most modern type of prosthesis is inadequate. Depth analysis of the patient’s ancillary conditions, medications, co-morbidities are required to select the most appropriate prosthesis type, which is an unavoidable responsibility of orthopedic surgeons. Orv Hetil. 2021; 162(20): 800–805.

A radiostereometric and clinical long-term follow-up study of the surface replacement trapeziometacarpal joint prosthesis

Background The aim of this study was to determine long-term survival and clinical outcomes of the surface replacement trapeziometacarpal joint prosthesis (SR™TMC) and to evaluate implant migration using radiostereometric analysis (RSA). Methods In this clinical long-term follow-up study outcomes of ten patients who received the SR™TMC joint prosthesis were evaluated using DASH and Nelson scores, Visual Analogue Scale (VAS) of pain, and key pinch strength. RSA-radiographs were obtained direct postoperatively and 6 months, 1, 5 and 10 years postoperatively and were analyzed using model-based RSA software. Results During follow-up, two early revisions took place. Mean pre-operative DASH and Nelson scores were 54 (SD 15) and 54 (SD 17), improved significantly after 6 months (DASH 25 (SD 20), Nelson 75 (SD 18)) and remained excellent during long-term follow-up in all patients with a stable implant. At final follow-up, clinical scores deteriorated clearly in two patients with a loose implant in situ. Conclusions Long-term survival of the SR™TMC joint prosthesis is relatively poor. However, clinical outcomes improved significantly in the short-term and remained excellent in the long-term in those patients with a stable implant, but deteriorated clearly in case of loosening. The role of RSA in TMC joint arthroplasty is potentially valuable but needs to be further investigated. Several challenges of RSA in the TMC joint have been addressed by the authors and suggestions to optimize RSA-data are given. Trial registration This study was registered in the Netherlands Trial Register (NL7126).

Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26 years

Background The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Methods We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint. Results The median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8). Conclusion In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants. Level of evidence III (Therapeutic).