SUMMARY Nine patients with rheumatoid arthritis, who had Silastic prostheses (Swanson's) introduced into 34 metacarpophalangeal joints, were reviewed 5 years after surgery. The most important long-term advantage conferred by the introduction of prostheses was pain relief; functional benefit was marginal. The majority of prostheses eventually fractured but this did not necessarily lead to a functional deterioration. Impairment of function was usually the result of loss of flexion at the metacarpophalangeal joints, but it was sometimes due to excessive instability after fracture of the prostheses. It is suggested that Silastic joint replacement may be a worthwhile procedure in rheumatoid patients with moderate destruction or deformity of the metacarpophalangeal joints when pain is a predominant feature. Significant functional improvement can be anticipated only when secondary to pain relief.We have already reported preliminary experiences with Silastic prostheses for replacement ofdestroyed metacarpophalangeal joints (MCP) in rheumatoid arthritis (Rhodes et al., 1972). The short-term results were, both objectively and subjectively, encouraging, but as the initial benefits of various forms of surgery to the rheumatoid hand are not always maintained it was, of course, necessary to extend the follow-up period. The surviving patients from the original series were reviewed 5 years after MCP joint replacement. PatientsOf the 11 patients in the original study 2 had died: the causes' of death were unrelated to the operations. 9 (2 male, 7 female) patients had survived and attended for 5-year postoperative follow-up. All the patients fulfilled the ARA criteria for definite or classical rheumatoid arthritis (Ropes et al., 1959): 8 were seropositive forrheumatoid factorand ofthese, 2 had shown evidence of digital vasculitis with nailfold lesions before surgery. The mean age at operation of the survivors was 55 years (range Accepted for publication September 23, 1977 Correspondence to Dr A. G. L. Kay, ARC Epidemiology Research Unit, Clinical Epidemiology Section, Guy's Hospital, St Thomas Street, London SEI 9RT years) and the mean duration of disease at the time of operation was 13 years (range 4-30 years). The operation was carried out on 34 joints in 11 hands. MethodA detailed examination was made of the hands including grip strength, range of movement of wrists, MCP joints, and proximal interphalangeal (PIP) joints. The presence or absence of pain, tenderness, swelling, and deformity was noted in the operated hands. X-rays of the hands and wrists were carried out. The findings were compared with the preoperative and early postoperative observations. A limited comparison was made between the operated and nonoperated hands in the 7 patients who had undergone surgery to one hand only.Methods of evaluation were similar to those of the preliminary study. The main changes were as follows. (1) Grip strength was quantitatively assessed, as previously, but not power grip. (2) Ranges of finger joint movement were measured using a...

Six cases are described of Beau's lines (transverse grooves in the fingernails) developing after injuries to the hand involving damage to nerves and flexor tendons. The literature is reviewed.

The incidence of a palmaris longus tendon in patients with Dupuytren's disease is significantly greater than in a control group with normal hands (p = 0.014). If a patient has a palmaris longus tendon, then there is a highly significant chance of Dupuytren's disease developing in that hand (p less than 0.001).

Use of silicone rubber ('Silastic') prostheses for the replacement of metacarpophalangeal (MCP) joints in rheumatoid arthritis was advocated by Swanson (1969), who considered the overall results of the operation superior to that of all previous surgical techniques. This report presents results of a short-term followup of twelve patients who had silastic MCP implants. Three subjects had joint replacements in both hands, nine in one hand; a total of 48 MCP joints were replaced in fifteen hands. All the operations were carried out by J. V. J. Material and methods Eleven patients suffered from rheumatoid arthritis and one from ankylosing spondylitis with severe hand-joint involvement. Their ages ranged from 39 to 69 years (mean 50); eight were female. The duration of disease ranged from 4 to 32 years (mean 17). Ten patients were seropositive (DAT), seven had rheumatoid nodules, and two had arteritis further complicated in one by peripheral neuropathy of the lower limbs.

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