Surgery of the forefoot in rheumatoid arthritis. 1960.
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Arthritis, Rheumatoid↗
Biomedical subjects
M L Clayton
Publications and source records attributed to M L Clayton.
Arthroplasty of rheumatoid metatarsophalangeal joints. An outcome study.
Deformity of the forefoot is a common disabling problem in chronic rheumatoid arthritis. The most common deformifies are hallux valgus, cockup toes, and depressed metatarsal heads. Resection arthroplasty has been improved by adding reconstructive procedures, for example, medial capsular arthroplasty in the great toe and plantar plate arthroplasty of the lesser toes with longitudinal pinning of all toes for 4 weeks. Results were compared with a series of silicone double hinge implants without grommets in the great toe and resection of lesser metatarsal heads and pinning. Patients were evaluated by questionnaire to evaluate outcome. There was no significant difference in the two series of patients. Overall good results were 85% to 95% and slightly favored the group without implants. These results were equal to those reported in the literature for patients who underwent fusion of the great toe and resection arthroplasty of lesser toes.
Adult↗
Results of CFV total wrist arthroplasty: review and early report.
Articulated total wrist arthroplasties have been used in the United States since 1974. In the 1980s the CFV wrist was developed in an attempt to reduce the incidence of imbalance, loosening, and bone resorption that has been seen in the early implants, and also to eliminate the use of bone cement. Since 1988, we have implanted 15 of these wrists. To date, nine patients are satisfied because of pain relief and motion; however, there have been 6 failures: 2 for infection, 3 because of a loose distal component, and 1 because of balance. Other problems that have been observed are flexor tenosynovitis, carpal tunnel syndrome, and a balancing problem.
Adult↗
Swanson silicone arthroplasty of the wrist in rheumatoid arthritis: a long-term follow-up.
Twenty-three Swanson silicone rubber implants in patients with stage III or stage IV rheumatoid arthritis were reviewed at an average of 72 months after surgery. Minimum follow-up in patients with unrevised implants was 44 months. Results were rated good or excellent in 48%, fair in 4%, and poor in 48%. Pain was the primary indication for surgery. Patient satisfaction and pain relief were achieved in 63%. Implant fracture occurred in 52%. Revision rate was 30%, including one recommended revision. Radiographic changes consistent with particulate synovitis were seen in 30%. Prosthesis settling and bony resorption were seen in more than 75% of the patients. Survivorship analysis demonstrated 42% survival at 77 months. Progressive clinical and radiologic deterioration was seen. Swanson silicone rubber implant is recommended only in the very low demand patient with stage III or stage IV rheumatoid arthritis and in those with insufficient bone stock to allow total wrist arthroplasty with a metal-on-plastic design.
Arthritis, Rheumatoid↗
Salvage for failed implant arthroplasty of the wrist.
We have had to revise 19 wrist arthroplasties--seven silicone implants and 12 metal-on-plastic total wrist arthroplasties. Each of the seven silicone implants was successfully revised in one operation; the four fusions and three total wrist implants were functioning 6 or more years after surgery. Nineteen operations were needed to revise the total wrist implants. Four had failed because of loosening, six had become unbalanced, and two had become infected. All of the loose prostheses eventually required fusion. Four of the unbalanced wrists were rebalanced, but two of these patients have pain; the other two cases required fusion. One infected wrist required fusion, and one is stable with an implant.
Arthritis, Rheumatoid↗
The Clayton total hip arthroplasty. A ten-year follow-up study.
Early success has been reported using a long-stem cemented femoral component in total hip arthroplasty (THA). The same patient group reported by the authors' institution at five years were reviewed again at ten years postarthroplasty. Certain trends can now be defined, including gradual deterioration in the Harris hip score, tendency toward failure of acetabular fixation (8.4% loosening rate requiring revision), and increased calcar resorption. Overall, the cemented femoral component has performed admirably, with a 97% success rate at ten-years' post-THA (3.1% revision rate). In this study, success was defined as arthroplasties that did not require revision. Ninety percent of observed patients were rated as good or excellent using the Harris hip score. The Clayton femoral component provides excellent durability by virtue of design.
Aged↗
Posterior cruciate condylar total knee arthroplasty. Average 11-year follow-up evaluation.
Forty-two total knee arthroplasties (TKAs) of the posterior cruciate condylar design performed from 1975 until 1978 were reviewed. Follow-up evaluations averaged 11 years. There were 21 knees each of osteoarthrosis and rheumatoid arthritis. The average postoperative knee score was 85.4 points. Thirty-nine knees (92.8%) were rated good or excellent, one (2.4%) was judged fair, and two (4.8%) were considered failures. Postoperative flexion averaged 104 degrees. Analysis of osteoarthritic versus rheumatoid arthritic subgroups demonstrated no significant differences in motion, alignment, or knee score. Roentgenographic review demonstrated no cases of femoral or tibial loosening, but one case of patellar component dislodgement was observed. Nonprogressive radiolucent lines were observed in 75% of the cases. Good results can be expected if satisfactory lower-extremity alignment is attained. Posterior cruciate ligament retention has provided a slightly improved postoperative range of motion. Residual problems appear to be centered about the patellofemoral joint.
Adult↗
Proximal row carpectomy: review of rheumatoid and nonrheumatoid wrists.
Proximal row carpectomy was first done in 1939 and was indicated for treatment of posttraumatic problems or Kienböck's disease. Use of this procedure in patients with rheumatoid arthritis has not been reported. Our series consists of eighteen wrists, nine with rheumatoid arthritis, and nine with other various nonrheumatoid conditions. Follow-up ranged from 12 to 120 months and included x-ray films and assessment of pain, range of motion, balance, grip strength, and patient satisfaction. Our results showed only two of the eight rheumatoid wrists to be satisfactory; failure was caused by pain and imbalance. Of the nonrheumatoid wrists, six of the eight were satisfactory, although in one of the six sclerosis is developing between the capitate and radius. Proximal row carpectomy is not recommended for the rheumatoid wrist but may be useful where other pathologic conditions are involved if the remaining articular surfaces are uninvolved.
Adult↗
Functional hallux rigidus in the rheumatoid foot.
Hallux rigidus results from arthritic involvement of the first metatarsophalangeal joint. The authors have observed loss of motion at this joint in patients with rheumatoid arthritis in the absence of hallux valgus or joint destruction. A hyperextension deformity of the interphalangeal joint has also been observed, with a painful callus beneath it. The first metatarsophalangeal joint appears normal on roentgenograms, and passive motion of the joint is normal when it is examined clinically. The loss of first metatarsophalangeal motion is functional, and stems from muscle spasm of the great toe intrinsic muscles in an effort to relieve pressure on the lesser metatarsal heads. The interphalangeal hyperextension may develop secondary to "functional hallux rigidus."
Adult↗
Capitello-Condylar total elbow arthroplasty for rheumatoid arthritis.
Twenty-one total elbow arthroplasties using the Capitello-Condylar design of Ewald were performed at the Denver Orthopedic Clinic from 1977 to 1986. Indications for operation included intractable pain unrelieved by medical therapy as well as late state III or IV rheumatoid arthritis. The average total elbow score at 48 months after operation was 89.5 points, including excellent pain and function ratings. Modest gains in motion occurred with lesser gains in patients with juvenile rheumatoid arthritis than those of the adult variety. Forty percent of the elbows suffered some type of complication although most are successfully manageable. There was one clinical failure due to deep infection in a renal deficient patient.
Adult↗
Internal fixation compression arthrodesis of the ankle.
Sixteen patients were treated by internal compression arthrodesis of the ankle using cancellous screw fixation. Thirteen patients had a preoperative diagnosis of traumatic osteoarthritis, and three patients had rheumatoid arthritis. All patients were followed until clinical and roentgenographic evidence of union had been obtained (average, 15.1 months). Union was obtained in 15 of 16 cases (94%) by an average of 9.2 weeks. The average ankle evaluation score was 77 points, with 80% of the patients rated good or excellent. Suboptimal results were attributed to technical errors. Midtarsal motion averaged 18 degrees, and subtalar motion was present in the majority of patients after surgery. This technique provides a high union rate while permitting early mobilization of the adjacent hindfoot and midfoot joints with earlier return to satisfactory function.
Adult↗
Keller arthroplasty in combination with resection arthroplasty of the lesser metatarsophalangeal joints in rheumatoid arthritis.
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Arthritis, Rheumatoid↗
Historical perspectives on surgery of the rheumatoid hand.
A history of rheumatoid hand surgery is presented, emphasizing the gains made through a team approach. This is not a complete literature review, but the history as the author has personally seen it develop over 40 years and as it affects today's surgical procedures.
Arthritis, Rheumatoid↗
Survivorship of unconstrained total shoulder arthroplasty.
The results of fifty-three unconstrained (Neer-II or Gristina) total shoulder arthroplasties were reviewed with the use of survivorship analysis. Failure was defined as the need for revision or the onset of the patient's dissatisfaction. The method of survivorship analysis is presented in detail. Fifty-one total shoulder arthroplasties were followed for a minimum of two years (average, sixty-seven months). The results are reported with the use of the American Shoulder and Elbow Surgeons' rating form. After eleven years, the survivorship was 73 per cent for all prostheses, 71 per cent for the Neer prostheses, and 92 per cent for all prostheses in patients who had rheumatoid arthritis. Data on survivorship of the Gristina prosthesis were available after four years only, at which time it was 100 per cent. The relief of pain, which was the primary reason for the operation, was good or excellent in 82 per cent, improved in 6 per cent, and poor in 12 per cent of the shoulders in these patients.
Adult↗
Carpal tunnel surgery: should the incision be above or below the wrist?
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Carpal Tunnel Syndrome↗
Osteoarthritis associated with a ball-and-socket ankle joint. A case report.
A ball-and-socket joint is an unusual disturbance of normal ankle development. Previous reports have noted good function and the absence of osteoarthritic change in ankles with this configuration. A 50-year-old man with no history of injury developed an osteoarthritic ball-and-socket deformity of the ankle joint. Associated musculoskeletal anomalies included toe syndactylization, genu valgum deformity, and tarsal coalition, a condition that may predispose to the development of this ankle anomaly. Associated valgus deformity of the ankle contributed to the osteoarthritic changes. The conspicuous absence of osteoarthritis in other joints of patients previously reported with this abnormality may be explained by the lack of long-term follow-up examinations.
Ankle Joint↗
Elbow synovectomy in rheumatoid arthritis. Long-term results.
Fifty-seven elbows in 46 rheumatoid arthritis patients were followed from one to 20 years, with an average follow-up period of 86 months, and were treated with synovectomy and radial head resection. A silicone radial head prosthesis was inserted in 13 elbows. Surgery was performed through a lateral incision. Long-term follow-up study showed 77% of the elbows to fall in the excellent and improved categories. A trend toward better results was seen if the surgery was done at an earlier stage of the disease. The radial head prosthesis did not influence the results of synovectomy.
Adult↗
Arthroplasty of the basal joint of the thumb using a silicone prosthesis. Long-term follow-up.
Thirty-three hands were followed for an average of 7.8 years after arthroplasty of the basal joint of the thumb using a silicone prosthesis. The minimum length of follow-up was 5.6 years. All of the patients had relief of pain, but three complained of weakness. Radiographs of twenty hands showed that four prostheses had subluxated, three had dislocated, and thirteen had evidence of wear. Ten hands had destructive changes in the adjacent bones. We now recommend the use of a silicone prosthesis for arthroplasty of the basal joint only in elderly patients or in patients who have a low level of functional activity. In younger or more active patients, interpositional arthroplasty using tendon is recommended.
Aged↗