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A Prospective Study Comparing Outcomes after Reconstruction in Rheumatoid Arthritis Patients with Severe Ulnar Drift Deformities

Chung, Kevin C. M.D., M.S.; Burke, Frank D. M.D.; Wilgis, E F. Shaw M.D.; Regan, Marian M.D.; Kim, H Myra Sc.D.; Fox, David A. M.D.

Plastic and Reconstructive Surgery: June 2009 - Volume 123 - Issue 6 - p 1769-1777
doi: 10.1097/PRS.0b013e3181a65b5a
Hand/Peripheral Nerve: Original Articles

Background: It has been stated by hand surgeons that rheumatoid arthritis patients often are referred “too little and too late.” The purpose of this prospective study was to evaluate outcomes of rheumatoid arthritis patients with metacarpophalangeal joint deformities (subluxation and ulnar deviation). The authors hypothesized that patients with more severe deformities would have worse outcomes after silicone metacarpophalangeal joint arthroplasty.

Methods: Seventy patients who each had combined metacarpophalangeal joint ulnar drift and extensor lag greater than 50 degrees were recruited into this three-center study of silicone metacarpophalangeal joint arthroplasty. Patients were categorized into two groups based on degrees of deformity: less than 100 degrees or greater than or equal to 100 degrees. Outcomes were assessed at 6 months and 1 year based on the Michigan Hand Outcomes Questionnaire, grip/pinch strength, metacarpophalangeal joint deviation angles, the Jebsen-Taylor test, and the Arthritis Impact Measurement Scales 2 questionnaire.

Results: There was no difference in outcomes at the 1-year follow-up between the two groups, after controlling for age, gender, and baseline values. Each of the outcome scores was not different between the two groups, including the six domains in the Michigan Hand Outcomes Questionnaire, grip/pinch strength, the Jebsen-Taylor test, and the Arthritis Impact Measurement Scales 2 questionnaire. However, patients with more severe hand deformities have worse ulnar drift and extensor lag after reconstruction.

Conclusions: Rheumatoid arthritis patients with more severe metacarpophalangeal joint diseases will attain similarly good outcomes after reconstruction when compared with those with less severe deformities. Despite the potential barriers to silicone metacarpophalangeal joint arthroplasty in rheumatoid arthritis patients with more severe hand deformities, surgical treatment is still beneficial.

Ann Arbor, Mich.; Baltimore, Md.; and Derby, United Kingdom

From the Section of Plastic Surgery, Department of Surgery, and Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System; the Pulvertaft Hand Center; the Curtis National Hand Center; the Derbyshire Royal Infirmary; and the Center for Statistical Consultation and Research, University of Michigan.

Received for publication November 21, 2008; accepted December 29, 2008.

Disclosures:This study was supported in part by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR047328) and a Midcareer Investigator Award in Patient-Oriented Research (K24 AR053120) (to K.C.C.). The authors have no other financial interest to declare in relation to the content of this article.

Kevin C. Chung, M.D., M.S.; 1500 East Medical Center Drive; 2130 Taubman Center; Ann Arbor, Mich. 48109-0340; kecchung@med.umich.edu

©2009American Society of Plastic Surgeons