A 10-Year Follow-Up of Uncemented Constrained Metacarpophalangeal Joint Arthroplasties Using the RM Prosthesis in a Patient with Rheumatoid Arthritis.

Abstract

A 72-year-old male with high-demand activities of daily living presented with rheumatoid arthritis mostly affected finger joints of his right hand. Radiographically, there was severe destruction with luxation of metacarpophalangeal joints (MCPJs) II-V. The constrained RM prostheses were inserted into the MCPJs II-V typically in the uncemented manner, and the course was primarily complicated due to periprosthetic fracture of the metacarpal IV intraoperatively, that was treated with immobilization in a plaster splint for 6 weeks. After that, the course was uncomplicated. Eight years after primary surgery, the patient reported increasing pain with loss of function isolated in his MCPJ IV since 6 months; all other finger joints did not reveal any clinically relevant symptoms. Radiographically, distinctive osteolyses with cortical thinning around all components of the 4 RM prostheses were seen, and the hinge joint of implant in MCPJ IV was broken. A total exchange arthroplasty of the MCPJ IV using the unconstrained MCPJ resurfacing SR TM MCP implant with cementation of both components was performed. At the 10-year follow-up, that includes a 2-year followup after MCPJ IV exchange arthroplasty, there was unchanged correct positioning of all MCPJ implants; and despite distinctive radiographic loosening and subsidence of the 3 other RM prostheses, the patient is able to perform his high-demand activities of daily living.

The rare injury of a closed digital extensor tendon avulsion of the third finger at its musculotendinous junction: Case presentation and brief overview of literature with regard to general, specific and practicable aspects to extensor tendon surgery involving tendon transfer procedures

“…Functional flexion postures averaged about 60° at the MCPJ and PIPJ, and 40° at the DIPJ [10,11]. Also noted that a well functioning and exactly aligned extrinsic extensor mechanism is an essential prerequisite for success of total joint replacements in the wrist and all other long finger joints (Figures 5A-C, 6A-H, and 7A-D) [8,9,12]. When an intratendinous disruption of an extrinsic extensor tendon is accompanied with a large gap, the bridging of gap utilizing a free tendon graft such as the palmaris longus (PL) is the method of choice for surgical repair (Figures 8A-D).…”

“…Furthermore, a stable and functioning MCPJ is the key for satisfactory function of the overall finger, hence, the preservation of its motion has a top priority [8,9]. The stable active extrinsic motionarc modulates synergistically the intrinsic function in the PIPJ for a powerful extension and fist conclusion.…”

Gout – Practicable Interdisciplinary Insights for the Clinician on a Surgeon’s Perspective

“…The main differential diagnosis for CTG is Rheumatoid Arthritis (RA). However, GA tends to be less symmetric than typical RA, and the non-chalk-like rheumatoid nodules typically appear polyarticular at the wrist and/or finger joints accompanied with its specific OA-related severe dislocations in volar and ulnar direction ( Figure 8A-8C) [6,51]. Other differential diagnoses for CTG are various subcutaneous tumors arising directly from bones, joints or its surrounding tissues ( Figures 9A-9H, 10) [52][53][54][55].…”