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Revision MCP arthroplasty produces 'reasonable' mid- to long-term implant survival
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BOSTON — Revision metacarpophalangeal arthroplasty resulted in “reasonable” 5- and 10-year implant survival rates, according to a speaker here.
“We conclude that metacarpophalangeal (MCP) arthroplasty performed in the revision setting has reasonable medium-term survival rates,” Eric R. Wagner, MD, said during his presentation at the American Society for Surgery of the Hand Annual Meeting. “Although there is a high rate of MCP joint instability when utilizing pyrocarbon or silicone implants, it seems to slightly minimize these results.”
Furthermore, Wagner said, it appears that MCP arthroplasty produces predictable pain relief and maintains or slightly improves patients’ arc of motion in the revision setting.
Wagner and colleagues used their institution’s total joint registry to identify 128 revision MCP arthroplasties performed during a 14-year period. Most patients had a diagnosis of inflammatory arthritis. Eighty-seven of the revised implants were silicone, 23 were pyrocarbon implants and 18 were surface replacement arthroplasty (SRA) implants. Most of the implants used during the revision procedures were silicone, followed by pryocarbon and SRA, according to Wagner.
“The implant survival in the MCP revision setting was relatively reasonable, with 81% at 5-year and 79% at 10-year survival rates,” Wagner said. “When breaking this out by implant type, SRA [implants] had significantly worse survival than the other two implants.”
The SRA implants had a 67% 5-year survival rate, compared with 83% for both the silicone and pyrocarbon implants.
Overall, the researchers found patients with prior instability and posttraumatic arthritis had significantly worse implant survival.
In terms of complications, there were 20 repeat surgeries with more than half performed for instability. Most postoperative complications were associated with MCP dislocation, Wagner said.
SRA implants were linked with significantly increased rates of instability when compared pyrocarbon and silicone implants, according to Wagner. — by Gina Brockenbrough.
Reference: Wagner ER. Paper #37. Presented at the: American Society for Surgery of the Hand Annual Meeting; Sept. 18-20, 2014; Boston.
Disclosure: Moran is a consultant for Integra. Wagner has no relevant financial disclosures.