[Synovialectomy of the metacarpophalangeal joints with reconstruction of the radial collateral ligaments -- long-term results in patients suffering from rheumatoid arthritis].
Rheumatoid arthritis may lead to destruction of MP joints and severe alteration of grip and other hand functions. Due to the improvement in medical treatment, synovialectomy of the MP joints is necessary only in late stages. Most centres prefer alloarthroplasties in late stages, as erosion of the cartilage and loosening of the ligaments have already led to destruction of the MP joints and destabilization of grip functions. We do not use alloarthroplasties as our first choice, but pay special attention to the reconstruction of the radial collateral ligaments. Therefore, the elongated radial ligaments are detached near their origin after synovialectomy of the dorsal aspects of the MP joint. After detachment of the radial ligament, the palmar aspects can be cleaned easily. The radial collateral ligaments are shortened and reinserted dorsally to gain slight supination. This study shows the long-term results of our patients. In a period of ten years, 74 patients (87 hands, 347 MP joints) were reexamined after an average of 55 months postoperatively. The loss of active motion was 18 degrees and ulnar deviation could be reduced from 25 degrees to 7 degrees. 71 % of the joints showed stable ligaments, 14 % loose, 15 % unstable ligaments. We saw recurrence of synovialitis in 18 % (10 % mild, 7 % significant, 1 % severe). Radiographs showed amelioration in 14 % of cases and deterioration in 39 %. There was no correlation between active range of motion, synovialitis and X-rays. Results were constant when compared with exams before and five years after surgery. Our investigation shows good and stable results, which can be easily compared with the outcome of other studies after alloarthroplasty. The main advantage in our procedure is the easy access to all parts of the MP joint, which allows complete synovialectomy. By shortening and reinserting the elongated radial collateral ligament, we achieve a mild supination and amelioration of grip strength. The results are constant in long terms. In case of recurrent synovialitis or loosening of the ligaments any other type of auto- and alloarthroplasties can still be performed.
Das Gupta
K
K
Abteilung für Handchirurgie, Plastische und Rekonstruktive Chirurgie, DRK-Klinik Baden-Baden. K.DasGupta@web.de
Haussmann
P
P
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008662:Metacarpophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012008:Recurrence; D000074402:Synovectomy; D013997:Time Factors; D016896:Treatment Outcome