Bioreconstructive Poly-L/D-Lactide Implant Compared With Swanson Prosthesis in Metacarpophalangeal Joint Arthroplasty in Rheumatoid Patients: a Randomized Clinical Trial
Restricted accessResearch articleFirst published online November, 2010
Bioreconstructive Poly-L/D-Lactide Implant Compared With Swanson Prosthesis in Metacarpophalangeal Joint Arthroplasty in Rheumatoid Patients: a Randomized Clinical Trial
It was hypothesized that the bioresorbable interposition implant might offer a viable alternative to conventional silicone implant arthroplasty in rheumatoid metacarpophalangeal joint destruction. A randomized clinical study was performed to compare a stemless poly-L/D-lactide copolymer 96: 4 (PLDLA) implant with the Swanson silicone implant. Results in 52 patients (53 hands and 175 joints) at a mean follow-up of 2 years (minimum 1 year) showed that the improvement in clinical assessments was comparable in both groups, except for better maintenance of palmar alignment in the Swanson group. The lack of implant fractures and intramedullary osteolysis were advantages of the PLDLA implant. The bioresorbable PLDLA interposition implant may offer an alternative tool for tailored reconstruction of rheumatoid metacarpophalangeal joints.
Blair WF, Shurr DG, Buckwalter JAMetacarpophalangeal joint implant arthroplasty with a Silastic spacer. J Bone Joint Surg Am. 1984, 66: 365-70.
4.
Burgess SD, Kono M., Stern PJResults of revision metacarpophalangeal joint surgery in rheumatoid patients following previous silicone arthroplasty. J Hand Surg Am. 2007, 32: 1506-12.
5.
Chung KC, Kotsis SV, Kim HMA prospective outcomes study of Swanson metacarpophalangeal joint arthroplasty for the rheumatoid hand. J Hand Surg Am. 2004 , 29: 646-53.
6.
Chung KC, Kowalski CP, Myra Kim H., Kazmers ISPatient outcomes following Swanson silastic metacarpophalangeal joint arthroplasty in the rheumatoid hand: a systematic overview. J Rheumatol . 2000, 27: 1395-402.
7.
Desrosiers J., Bravo G., Hebert R., Dutil E., Mercier L.Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Arch Phys Med Rehabil. 1994, 75: 751-55.
8.
Goldfarb CA, Dovan TTRheumatoid arthritis: silicone metacarpophalangeal joint arthroplasty indications, technique, and outcomes. Hand Clin. 2006, 22: 177-82.
9.
Goldfarb CA, Stern PJMetacarpophalangeal joint arthroplasty in rheumatoid arthritis. A long-term assessment. J Bone Joint Surg Am. 2003, 85: 1869-78.
10.
Honkanen PB, Kellomaki M., Konttinen YT, Makela S., Lehto MUA midterm follow-up study of bioreconstructive polylactide scaffold implants in metacarpophalangeal joint arthroplasty in rheumatoid arthritis patients . J Hand Surg Eur. 2009, 34: 179-85.
11.
Honkanen PB, Kellomaki M., Lehtimaki MY, Tormala P., Makela S., Lehto MUBioreconstructive joint scaffold implant arthroplasty in metacarpophalangeal joints: short-term results of a new treatment concept in rheumatoid arthritis patients. Tissue Eng. 2003, 9: 957-65.
12.
Ikavalko M., Skytta ET, Belt EAOne-year results of use of poly-L/Dlactic acid joint scaffolds and bone packing in revision metacarpophalangeal arthroplasty. J Hand Surg Eur. 2007, 32: 427-33.
13.
Kellomäki M., Puumanen K., Waris T., Törmäla P.In vivo degradation of composite membrane of P(e-CL/LLA) 50/50 film and P(L/D)LA 96/4 mesh. In: Stallforth H, Revell P (Eds.) Materials for Medical Engineering . Weinheim, Wiley-VCH, 2000: 73-9.
14.
Lansman S., Paakko P., Ryhanen J. et al. Poly-L/D-lactide (PLDLA) 96/4 fibrous implants: histological evaluation in the subcutis of experimental design. J Craniofac Surg. 2006, 17: 1121-8.
15.
Larsen A., Dale K., Eek M.Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn. 1977, 18: 481-91.
16.
Mandl LA, Galvin DH, Bosch JP et al. Metacarpophalangeal arthroplasty in rheumatoid arthritis: what determines satisfaction with surgery?. J Rheumatol. 2002, 29: 2488-91.
17.
Moller K., Sollerman C., Geijer M., Kopylov P., Tagil M.Avanta versus Swanson silicone implants in the MP joint - a prospective, randomized comparison of 30 patients followed for 2 years. J Hand Surg Br. 2005, 30: 8-13.
18.
Parkkila T., Belt EA, Hakala M., Kautiainen HJ, Leppilahti J.Grading of radiographic osteolytic changes after silastic metacarpophalangeal arthroplasty and a prospective trial of osteolysis following use of Swanson and Sutter prostheses. J Hand Surg Br. 2005 , 30: 382-7.
19.
Parkkila T., Belt EA, Hakala M., Kautiainen HJ, Leppilahti J.Survival and complications are similar after Swanson and Sutter implant replacement of metacarpophalangeal joints in patients with rheumatoid arthritis. Scand J Plast Reconstr Surg Hand Surg. 2006a, 40: 49-53.
20.
Parkkila T., Hakala M., Kautiainen H., Leppilahti J., Belt EAOsteolysis after Sutter metacarpophalangeal arthroplasty: a prospective study of 282 implants followed up for 5.7 years. Scand J Plast Reconstr Surg Hand Surg. 2006b, 40: 297-301.
21.
Saikku-Backstrom A., Tulamo RM, Raiha JE et al. Intramedullary fixation of cortical bone osteotomies with absorbable self-reinforced fibrillated poly-96L/4D-lactide (SR-PLA96) rods in rabbits . Biomaterials. 2001, 22: 33-43.
22.
Schmidt K., Willburger RE, Miehlke RK, Witt K.Ten-year follow-up of silicone arthroplasty of the metacarpophalangeal joints in rheumatoid hands. Scand J Plast Reconstr Hand Surg. 1999, 33: 433-38.
23.
Swanson ABFlexible implant arthroplasty for arthritic finger joints: rationale, technique, and results of treatment. J Bone Joint Surg Am. 1972, 54: 435-55.
24.
Trail IA, Martin JA, Nuttall D., Stanley JKSeventeen-year survivor-ship analysis of silastic metacarpophalangeal joint replacement. J Bone Joint Surg Br. 2004, 86: 1002-6.
25.
Vainio K.Vainio arthroplasty of the metacarpophalangeal joints in rheumatoid arthritis . J Hand Surg Am. 1989, 14: 367-8.
26.
Waris E., Ashammakhi N., Lehtimaki M. et al. The use of biodegradable scaffold as an alternative to silicone implant arthroplasty for small joint reconstruction: an experimental study in minipigs. Biomaterials. 2008, 29: 683-91.
