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PubMed1985

Total joint replacement.

As of 1980, approximately 1,800,000 people reached the age of 65 each year in the United States. It may be estimated that each year 35,000 of these people would benefit from total hip replacement surgery and are medically fit for it. Numbers for knee replacement are similar. Other joint replacements are much less in number but may be equally done when indicated. With the constant improvement of surgical technique, prostheses, and medical expertise, these people can be offered significant improvement in the quality of life by replacement of painful disabling joints.

Aged↗
PubMed1984

Metacarpophalangeal joint arthroplasty eleven year follow-up study.

During a period from April, 1972 to May, 1983, 339 Swanson silastic implants were implanted in eighty-two hands of fifty-five patients. A follow-up study was performed to evaluate the long-term function of these implants. Our follow-up study indicates that metacarpophalangeal joint arthroplasty can relieve pain, correct deformity, improve appearance and improve hand function by providing functional motion and stability. Few long-term problems were noted and the functional benefits gained by surgery decreased little with time. Patient satisfaction was high.

Adult↗
PubMed1997

Hand function following Silastic arthroplasty of the metacarpophalangeal joints in the rheumatoid hand.

Twenty-one consecutive rheumatoid patients (23 hands, 92 joints) who underwent Silastic metacarpophalangeal joint arthroplasty between 1989 and 1993 had the 33-task Baltimore quantitative upper extremity function test prior to surgery and then repeated at intervals from 6 weeks to 1 year for all 23 hands and 3 to 4 years for 14 of the hands. In addition all hands had goniometer measurement of active range of finger joint motion and ulnar drift at each assessment. The average preoperative score was 71 improving rapidly to 89 at 6 weeks, to 91 at 1 year and 92 at 3 to 4 years. Most improvement occurred in functions requiring pinch span or hook grip and could be attributed largely to correction of ulnar drift and the change of metacarpophalangeal arc of motion. These results confirm that the Silastic metacarpophalangeal joint arthroplasty significantly improves hand function and that the improvement is maintained over a 3- to 4-year period.

Adult↗
PubMed2000

Salvage first MTP arthrodesis utilizing ICBG: clinical evaluation and outcome.

Twelve patients (12 feet) underwent salvage first metatarsalphalangeal (MTP) arthrodesis with structural, interposition autologous iliac crest bone graft (ICBG). Eight patients had a bony defect secondary to failed first MTP joint implant arthroplasties, two had avascular necrosis (AVN) after failed bunion surgery, one had a nonunion of an attempted arthrodesis for failed bunion surgery, and one had been treated for osteomyelitis after cheilectomy. Eleven of the cases had a single dorsal plate secured by screws and one case had two plates, one dorsal and one medial. A plate, crossed screw(s) and/or K-wire combination were chosen in four cases. Indications included first MTP joint pain, metatarsalgia, intractable plantar keratoses (IPK), as well as a functionally and cosmetically short first ray refractory to non surgical management. Average preoperative shortening was 8.5 mm (range 5-17). Clinical arthrodesis was achieved after an average of 12 weeks (range 4-20). Radiographic arthrodesis was achieved in eleven of twelve feet at an average of 15 weeks (range 8-28), with one pseudoarthrosis. AOFAS forefoot clinical rating score averaged 70 points (max 90 after first MTP arthrodesis) at an average follow-up of 22 months (range 5-70). Sesamoiditis, prominent hardware and scar sensitivity were prevalent complaints in four patients postoperatively. Two cases required flap coverage for skin necrosis. Relief of metatarsalgia, good hallux alignment as well as improved patient satisfaction and function were achieved in all cases. There was no symptomatic progression of interphalangeal degenerative change postoperatively.

Adult↗
PubMed1999

Osseointegrated silicone implants. 18 patients with 57 MCP joints followed for 2 years.

20 patients were operated on consecutively with osseointegrated MCP joint prostheses in 64 joints at our department between September 1993 and February 1995. The one-stage procedure included joint resection and cancellous bone grafting from the iliac crest before insertion of screw-shaped titanium fixtures, connected with a flexible silicone spacer. 18 patients (57 joints) were clinically and radiographically examined at median 28 (18-37) months postoperatively. Indications for surgery were joint destruction due to chronic arthritis in 17 patients (56 joints), and posttraumatic arthrosis in 1 patient (1 joint). Postoperative median range of motion was 40 (15-85) degrees, with an extension deficit of 30 (-20-70) degrees. 16 patients were satisfied, and had good pain relief and substantially improved postoperative hand function, evaluated with the standardized Sollerman hand function test. Radiographic osseointegration was obtained in 112 of 114 titanium fixtures (98%), but fracture of the silicone spacer was observed in 14 implants (25%). We conclude that osseointegration of longitudinal titanium fixtures in the bone marrow canal is possible in a one-stage procedure, but our findings show the need for a new, more durable joint spacer.

Adult↗
PubMed1976

[Total shoulder endoprosthesis design St. Georg].

Experiences with shoulder replacement in 40 cases since 1966 and the development of a nonblocked total prosthesis are described. The replacement of both joint surfaces according to the principles of low friction arthroplasty ist needed to obtain relief of pain. The nonblocked system corresponds in a high degree to physiologic conditions. The shape of the implant and the meticulous reconstruction of the inner and outer rotator cuffs reduce the danger of dislocation considerably. Only small bone resection is necessary. In cases of dislocated compound fractures and of painful posttraumatic and rheumatic arthrosis, total replacement could be an alternative to resection of the humeral head as well as to shoulder arthrodesis.

Adult↗
PubMed2005

[Results after arthroplasty of the metacarpophalangeal joints with uncemented, unconstrained HM prosthesis in rheumatoid patients].

PURPOSE: In 80 % of patients with rheumatoid arthritis, the metacarpophalangeal (MP) joints are involved with increasing destruction and loss of function. Silicone arthroplasty of the MP joints leads to a limited range of motion, an increase in osteolysis and fractures of the implants. The cementless, unconstrained design of the HM prosthesis is a new concept for replacing the MP joints of rheumatoid patients. Short-term and midterm results are shown. METHOD AND MATERIAL: In a prospective study, 38 HM prostheses were implanted, 28 in patients with rheumatoid arthritis, four with osteoarthrosis, five with polyarthrosis and one after revision of a silicone implant. The patients were reexamined clinically and radiologically after an average follow-up of 16 months (6 - 37 months). RESULTS: The average active range of motion for extension, flexion increased from 0/15/65 degrees before surgery to 0/9/65 degrees after surgery. The remaining ulnar drift was 12 degrees (preoperative 18 degrees ). The average grip strength after surgery was 80 % of the opposite side. Pain in the verbal analog scale improved from 2.3 to 1.7 postoperatively. One palmar subluxation of an implant of the little finger was recognized. No infection occurred. The X-rays showed complete osteointegration in all metacarpal components. Radiolucent zones were found in progress only at the basis on the phalangeal components without radiological signs of loosening or sinking. CONCLUSION: The short- and midterm results after implantation of the cementless, unconstrained HM prosthesis show an improved hand function and pain relief. The design of the implant may solve the accepted postoperative problem of instability of the MP joints. Until now, no prosthesis had to be exchanged.

Adult↗
PubMed1981

Total replacement arthroplasty of the first metatarsophalangeal joint.

A surface replacement prosthesis for the first metatarsophalangeal joint has been designed to be used in arthritic conditions of this joint. The components are made of stainless steel and polyethylene and fixed with methylmethacrylate. The surgical details of insertion are important in such a complex, small joint. In the series of 20 patients (21 joints), the patient and physician satisfaction rate was 81% at an average follow-up period of 43 months (range 16 to 58 months). Current use of this prosthesis is most reasonable in older patients with painful degenerative arthritis of the first metatarsophalangeal joint and minimal joint imbalance.

Adult↗
PubMed2005

A long-term follow-up of silicone-rubber interposition arthroplasty for osteoarthritis of the thumb carpometacarpal joint.

There are several surgical options for osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint. This paper presents our long-term clinical and radiographic review of 12 thumbs in ten patients treated by partial trapezial excision and silicone-rubber interposition arthroplasty. The follow-up period averaged 15; three years with a ten-year minimum. Although the procedure provided early pain relief in most thumbs, all but two had mild to severe pain at follow-up. The average range of post-operative palmar abduction was 23 degrees. The average post-operative grip strength was 9.5 kg. Both tip and key pinch between thumb and index finger averaged about 50% that of normal subjects. Dislocation of the implant occurred in two joints and breakages in five. Bony erosions around the implant, which we attributed silicone synovitis, were found in four thumbs. The indications for silicone-rubber interposition arthroplasty for OA of the thumb CMC joint should be severely restricted as these produced unsatisfactory long-term results.

Activities of Daily Living↗