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Revision Metacarpophalangeal Arthroplasty

A Longitudinal Study of 128 Cases

Wagner, Eric R., MD, MS; Houdek, Matthew T., MD, MS; Packard, Benjamin, MD; Moran, Steven L., MD; Rizzo, Marco, MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: March 15, 2019 - Volume 27 - Issue 6 - p 211–218
doi: 10.5435/JAAOS-D-17-00042
Research Article

Purpose: The objective was to examine outcomes associated with a large cohort of revision metacarpophalangeal (MCP) arthroplasties.

Methods: A review of 128 revision MCP arthroplasties performed in 64 patients was performed. The mean age at surgery was 62 years. Fifty nonconstrained (31 pyrocarbon and 19 surface-replacing arthroplasty) and 78 constrained silicone implants were used for revisions.

Results: At a follow-up of 6 years (2 to 16), 20 (16%) implants required a secondary revision surgery. The 5- and 10-year survival rates were 81% and 79%, respectively. Postoperative dislocation occurred in 17 (13%) MCP joints. Subgroup analysis demonstrated a 5-year survival rate of 67% in surface-replacing arthroplasties, compared with 83% for both pyrocarbon and silicone implants (hazard ratio, 2.60; P = 0.09). Clinical improvements in pain and MCP range of motion were noted in most patients postoperatively.

Conclusions: Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations. However, most patients who did not undergo a secondary revision surgery experienced improvements in pain and range of motion. Worse outcomes are seen in patients with a history of MCP dislocations.

Level of Evidence: Level IV

From the Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.

Correspondence to Dr. Rizzo: rizzo.marco@mayo.edu

Dr. Moran or an immediate family member has received royalties from and serves as a paid consultant to Integra LifeSciences; has stock or stock options held in AxoGen; and serves as a board member, owner, officer, or committee member of the American Society for Surgery of the Hand. Dr. Rizzo or an immediate family member serves as a paid consultant to Zimmer Biomet and serves as a board member, owner, officer, or committee member of the American Association for Hand Surgery and the American Society for Surgery of the Hand. None of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Wagner, Dr. Houdek, and Dr. Packard.

© 2019 by American Academy of Orthopaedic Surgeons
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