title: The mean seven years' results of the use of poly-L/D-lactic acid (PLDLA) interposition implant and bone packing in revision metacarpophalangeal arthroplasty: a prospective cohort study.
abstract: OBJECTIVE
  Revision arthroplasty of metacarpophalangeal (MCP) joints in chronic inflammatory arthritis patients after silicone implants is challenging due of severe bone loss and soft tissue deficiencies. The aim of this study was to evaluate the outcome of revision MCP arthroplasty using poly-L/D-lactic acid 96:4 (PLDLA) interposition implant and morcelised allograft or autograft bone packing in patients with failed MCP arthroplasties and severe osteolysis.
  
  
  METHODS
  The study group consisted of 15 patients (15 hands and 36 joints) at a mean follow-up of seven years (range 5-10 years). The radiographs were reviewed for osteolysis and incorporation of the grafted bone. The clinical assessments included active range of motion, evaluation of pain, subjective outcome and assessment of grip power.
  
  
  RESULTS
  PLDLA interposition arthroplasty combined with bone packing provided satisfactory pain relief, but function was limited. Radiographic analysis showed complete incorporation of the grafted bone to the diaphyseal portion of the host metacarpal and phalangeal bones in 30 of the 36 joints. All the patients had very limited grip strength, both on the operated and non-operated side.
  
  
  CONCLUSIONS
  Due to soft tissue deficiencies long-term function and alignment problems can not be resolved with PLDLA interposition implant.
authors.affiliation: Department of Orthopaedics, Päijät-Häme Central Hospital, Lahti, Finland. raine.tiihonen@phsotey.fi
authors.forename: R
authors.initials: R
authors.lastname: Tiihonen
authors.forename: P B
authors.initials: PB
authors.lastname: Honkanen
authors.forename: E A
authors.initials: EA
authors.lastname: Belt
authors.forename: M
authors.initials: M
authors.lastname: Ikävalko
authors.forename: E T
authors.initials: ET
authors.lastname: Skyttä
mesh_terms: D001168:Arthritis / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000295:instrumentation* / Q000379:methods; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D019344:Lactic Acid; D008662:Metacarpophalangeal Joint / Q000601:surgery*; D010014:Osteolysis / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D011091:Polyesters; D011108:Polymers; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012828:Silicones; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D011091:Polyesters; D011108:Polymers; D012828:Silicones; D019344:Lactic Acid; C033616:poly(lactide)