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Silicone arthroplasty offers significant clinical improvement for RA at 1 year
Prospective level 2 cohort study compared results of surgery with medically treating patients with RA.
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In the first large-scale prospective study comparing surgical outcomes after silicone arthroplasty and nonsurgical management for severe rheumatoid arthritis of the hand, researchers found markedly improved function in the surgically treated patients at 1 year.
They noted that function did not deteriorate in nonsurgical patients at the same follow-up.
“This is actually an encouraging study for us,” said Kevin C. Chung, MD, MS, professor of plastic surgery at the University of Michigan. It provides hand surgeons and rheumatologists with evidence-based data they can use to enhance care of their patients with rheumatoid arthritis, he said at the American Society for Surgery of the Hand 63rd Annual Meeting.
Severe MCP disease
Over 3 years, the investigators enrolled patients who had severe metacarpophalangeal (MCP) joint disease into the study, including severe subluxation and/or ulnar finger deviation at the MCP joint. There were 163 patients with 1-year follow-up results; 70 patients in the surgical group and 93 in the nonsurgical group.
Patients were enrolled at centers in Ann Arbor, Baltimore and Derby, England. Chung and colleagues conducted followed-up evaluations at the 6-month, 1-, 2- and 3-year time points.
Standard measures
According to Chung, the groups were highly similar in terms of their mean age and other demographic factors did not differ significantly among the two groups.
Researchers evaluated outcomes at 1 year with standard scales and measures intended for use in the rheumatoid hand population, such as the Michigan Hand Outcomes Questionnaire (MHQ), arthritis intact measurement scale (AIMS), functional testing, and measurements of range of motion and ulnar deviation.
Their comparison of outcomes of surgical vs. nonsurgical patients at 1 year showed no change in the nonsurgical group, which was in sharp contrast to the significant improvement seen in MHQ scores in the operative group.
“This study is particularly novel because we have a control group to verify the functional improvement over time,” Chung noted.
For more information:
- Kevin C. Chung, MD, MS, can be reached at University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109; 734-998-6022; e-mail: kecchung@umich.edu. He received grant support from the National Institute of Arthritis and Musculoskeletal and Skin Disease (RO1 AR0473228).
Reference:
- Chung KC, Wilgis EFS, Burke FD, et al. A prospective outcomes study comparing silicone arthroplasty vs. medical treatment. Paper #4. Presented at the American Society for Surgery of the Hand 63rd Annual Meeting. Sept. 18-20, 2008. Chicago.