Orthopedics & Rheumatology

Biography

Biography: Mithun Neral

Abstract

Abstract Introduction: Silicone arthroplasty of the metacarpophalangeal joint (MCP) is a well-established treatment for rheumatoid arthritis. However, available literature on treatment of non-rheumatic arthritis is limited to case reports and retrospective reviews of small patient populations. Purpose: The purpose of this study is to evaluate the clinical effectiveness of MCP arthroplasty for non-rheumatic arthritis in the largest group of patients with the longest follow-up period to date. We predict that MCP arthroplasty for non-rheumatic arthritis shows significant improvement in hand function, pain relief and patient satisfaction. Materials & Methods: A search of all MCP arthroplasties performed by a single surgeon for non-rheumatic arthritis over a 12-year period found 136 arthroplasties. Of these, adequate prospective follow-up assessment could be completed for 30 patients with 38 MCP arthroplasties at an average of 56 months after surgery. Objective measures included are range of motion (ROM), grip and pinch strength, disabilities of the arm, shoulder, and hand (DASH) score, and visual-analog pain score. Follow-up x-rays were reviewed. Patients also completed a subjective patient-satisfaction questionnaire. Mean ROM, DASH, and pain were compared between the pre-operative and follow-up groups by paired T-test and linear regression to identify significant differences and trends in long-term follow-up. Results: There was significant improvement between mean pre-operative and follow-up ROM, DASH, and pain with p-values of 0.0006, 0.0007 and <0.0001, respectively. Mean follow-up ROM, DASH, and pain scores were 69.5±3.0, 15.0±2.3 and 0.76±0.2, respectively. Linear regression showed significant correlations between pre-operative measurements and improvement at follow-up for ROM, DASH, and pain with p-values of 0.0003, 0.0310, and <0.0001, respectively. No significant difference existed for grip (p=0.593) or pinch (p=0.296) strength when follow-up operative and non-operative hand strengths were compared. The patient-satisfaction questionnaire showed 73% were “very satisfied”, 87% would “definitely do it again”, and 70% experience “rare or no pain.” Follow-up x-rays showed 5° mean angulation and 2 mm mean subsidence compared to immediate post-operative X-rays. Four arthroplasties required revision, for an 11% revision rate. Conclusions: This study showed improved ROM and DASH score, excellent pain relief, and excellent patient satisfaction in patients undergoing MCP arthroplasty for non-rheumatic arthritis. Patients with more severe ROM limitation, DASH score and pain score experienced a greater improvement of these measures at follow-up. Strength improvement is limited although remains comparable to the non-operative hand. Angulation, subsidence and complications in the study population are consistent with those reported in current literature.