title: Long-term followup for rheumatoid arthritis patients in a multicenter outcomes study of silicone metacarpophalangeal joint arthroplasty.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) often results in deformities at the metacarpophalangeal (MCP) joints. Patients with severe deformities can be treated by silicone metacarpophalangeal joint arthroplasty (SMPA). The objective of the study is to prospectively compare long-term outcomes for an SMPA surgical and a nonsurgical cohort of RA patients.
  
  
  METHODS
  A total of 67 surgical and 95 nonsurgical patients with severe subluxation and/or ulnar drift of the fingers at the MCP joints were recruited from 2004-2008 in this multicenter prospective cohort study. Patients could elect to undergo SMPA or not. Outcomes included the Michigan Hand Outcomes Questionnaire (MHQ), Arthritis Impact Measurement Scales 2 (AIMS2), grip/pinch strength, Jebsen-Taylor Test, ulnar deviation, extensor lag, and arc of motion measurements at the MCP joints.
  
  
  RESULTS
  There was no significant difference in the mean age, race, education, and income at baseline between the 2 groups. Surgical subjects had worse MHQ function and functional measurements at baseline. At 3 years, the mean overall MHQ score and the MHQ function, activities of daily living, aesthetics, and satisfaction scores showed significant improvement in the surgical group compared to the nonsurgical group. Ulnar deviation, extensor lag, and arc of motion in the MCP and proximal interphalangeal joints also improved significantly in the surgical group. No improvement was seen in the mean AIMS2 scores and grip/pinch strength. Complications were minimal with a fracture rate of 9.5%.
  
  
  CONCLUSIONS
  RA patients with poor baseline functioning showed long-term improvement in hand function and appearance following treatment with SMPA compared to nonsurgical controls.
authors.affiliation: University of Michigan Health System, Ann Arbor, 48109-5340, USA. kecchung@med.umich.edu
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Burns
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Frank D
authors.initials: FD
authors.lastname: Burke
authors.forename: E F Shaw
authors.initials: EF
authors.lastname: Wilgis
authors.forename: David A
authors.initials: DA
authors.lastname: Fox
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D050806:Arthroplasty, Replacement, Finger / Q000009:adverse effects / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D017558:Elective Surgical Procedures; D004739:England; D005260:Female; D018737:Hand Strength; D006801:Humans; D007595:Joint Prosthesis; D016015:Logistic Models; D008297:Male; D008662:Metacarpophalangeal Joint / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012828:Silicones; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D012828:Silicones