Experience with Silastic prostheses in the rheumatoid hand. A 5-year follow-up.

Abstract

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...

Silastic arthroplasty in rheumatoid MCP-joints

“…Ulnar deviation and volar displacement were reduced significantly after the operation and recurred in only a few joints. Our results confirm previous studies (Swanson 1969 Kay et al 1978, Gschwend 1980.…”

“…Our follow-up was too short to disclose the entire gamut of late complications; the incidence of implant fractures increases with the period of observation (Hagert et al 1975, Kay et al 1978.…”

“…In advanced stages, several techniques for reconstructive surgery are available (Kestier 1946, Vainio et al 1967, Weilby 1977. In recent years joint spacers, notably the Swanson silastic prosthesis, have gained wide acceptance (Swanson 1969 Kay et al 1978, Gschwend 1980. We have reviewed our experience with this prosthesis.…”

Silastic arthroplasty in rheumatoid MCP-joints: 60 joints followed for 7 years

“…In 1972 Swanson reported that implant fractures occurred in fewer than 2 percent; according to Swanson and Swanson (1984) most fractures will occur within the first 2 years. Others have reported that the incidence of fractures increases with the observation time (Hagert et al 1975, Kay et al 1978. This was confirmed in our series, as we found fractures in 5 patients, whereas 5 years earlier we had only 1 patient with fractured implants.…”

Anatomically Neutral Silicone Small Joint Arthroplasty for Osteoarthritis

“…Although osteoarthritis more commonly affects the proximal interphalangeal (PIP) joint, the use of silicone implants at this joint has been infrequently studied since Swanson's initial investigations. [1][2][3][4] The Swanson implant has historically been recognized as a mainstay in small joint arthroplasty of the hand; however, high rates of implant fracture, as high as 82% within 5 years of insertion, [5][6][7][8][9] have encouraged investigators to search for alternatives, including those with an anatomically neutral resting position, such as first introduced with the NeuFlex implant (DePuy, Warsaw, IN). The term anatomically neutral refers to the implant's preformed 30°resting angle that approximates the relaxed position of the human hand.…”