Functional and patient-reported outcomes of the Swanson metacarpo-phalangeal arthroplasty in the rheumatoid hand.
BACKGROUND
Replacement of the metacarpo-phalangeal joints (MCPJ) with silastic Swanson's implants can help decrease pain, stiffness and allow for improved function in rheumatoid arthritis (RA). There is a lack of patient reported outcome measure (PROM) studies assessing the efficacy of this procedure in RA. The aim of this study was to report any change in function, pain, stiffness and satisfaction following the Swanson MCPJ replacement using patient reported outcomes in a rheumatoid population.


METHODS
The combined results of 64 RA patients (71 hands) with 284 Swanson MCPJ arthroplasties (mean follow-up: 75.85 months) were assessed using the validated M-SACRAH questionnaire and a separate satisfaction questionnaire. Radiographic evaluation was performed to insure correct alignment of the hinged prosthesis postoperatively. No attempt was made to identify other predictors, radiologically or clinically. Data analysed in the study was interpreted in the context of the number of hands and survivorship was defined as implant fracture, loosening or revision.


RESULTS
The mean total functional outcome score improved by 46.2% and the total pain outcome improved by 60.2%. The total stiffness outcome improved by 56.9% postoperatively and the results obtained from the satisfaction questions revealed that 73.2% of patients would retrospectively elect to have the procedure again. We report two postoperative complications in this group of superficial wound infections. Radiographically, all MCPJs showed improved alignment, however five patients reported worsening pain, four patients reported increased stiffness and four reported reduced function postoperatively. There was one re-operation of a 5th MCPJ Swanson's, which did not require implant exchange and one implant was revised. Implant survivorship was 98.6%.


CONCLUSIONS
Patient satisfaction and functional surrogate markers were overall favourable. Our results support the continued use of Swanson silastic arthoplasty in advanced RA.
Department of Orthopaedic Surgery, New Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK. felherik@hotmail.co.uk.
Firas K
FK
Elherik
University of Dundee Medical School, Ninewells Hospital, Dundee, DD2 1UB, UK.
Sean
S
Dolan
Department of Orthopaedic Surgery, New Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK.
John
J
Antrum
Department of Hand Surgery, Vulpiusklinik, Bad Rappenau, Germany.
Frank
F
Unglaub
Department of Orthopaedic Surgery, New Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK.
Colin R
CR
Howie
Department of Orthopaedic Surgery, New Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK.
Steffen J
SJ
Breusch
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000601:surgery; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D003286:Contracture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005260:Female; D050278:Finger Phalanges / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000601:surgery; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011859:Radiography / Q000379:methods; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies
M-SACRAH; Metacarpo-phalangeal joint; Patient-reported outcome measures; Rheumatoid arthritis; Silastic implants; Swanson