Long-Term Follow-Up of Swanson’s Silastic Arthroplasty of the Metacarpophalangeal Joints in Rheumatoid Arthritis

Abstract

77 patients with rheumatoid arthritis, 62 female and 15 male, underwent metacarpophalangeal joint arthroplasty on 375 joints using the Swanson design silicone rubber spacer between 1976 and 1985. Retrospectively, 48 of these patients were evaluated by postal questionnaire and 35 of them also underwent objective assessment at intervals ranging from five to 14 years post-operatively. Objective variables recorded included range of active motion, recurrence of ulnar drift and radiographic appearances. Both in the early and late stages, the vast majority of patients were satisfied with the outcome, with abolition of pain, correction of deformity and improved range of motion. There was some loss of mobility with time. However, functional improvement was maintained in the majority. Complication rates compare favourably with other reported series and no case of silicone synovitis was diagnosed. We agree with previous studies that the procedure is useful for lasting relief of pain and enhancement of a patient's sense of well-being and is associated with few complications.

Biomaterials in orthopaedics

“…Other drawbacks include subluxation, bone erosion, loosening and implant abrasion (Hirakawa et al 1996). A key issue in the success of silicone-based implants lies in the appropriate design of the device mimicking the normal characteristics of the joint (El-Gammal & Blair 1993;Wilson et al 1993).…”

A prospective outcomes study of Swanson Metacarpophalangeal Joint Arthroplasty for the rheumatoid hand

“…The Swanson silicone implant (Dow Corning, Midland, MI) has emerged as the preferred choice because of its flexibility and durability. 3 We chose to use the Swanson implant in this study because it is the most commonly used implant, having 75% of the US market for implants in the rheumatoid hand (personal communication, Wright Medical Technology, Arlington, TN). Despite the long-term use of Swanson implants, most published reports consist of uncontrolled retrospective case series that were based mainly on physical outcomes such as finger range of motion, grip strength, and degrees of residual ulnar drift.…”

Metacarpophalangeal arthroplasty from the patient's perspective

“…Studies using objective assessments have generally assessed the technical success of the surgery, assessing aspects such as joint alignment, 2 periprosthetic effects such as bone resorption, 3 implant loosening, 4 fracture, 5 functional outcomes such as range of motion and pinch and grip strength, 6 and postoperative complications such as infection or silicone lymphadenopathy. 7 Some studies have reported patients' performance in hand assessments.…”