Wanderman Nathan, Wagner Eric, Moran Steven, Rizzo Marco
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Hand Surg Am. 2018 Mar;43(3):289.e1-289.e6. doi: 10.1016/j.jhsa.2017.10.001. Epub 2017 Nov 11.
There remains a paucity of information regarding the treatment outcomes of dislocation after metacarpophalangeal (MCP) joint arthroplasty. The purpose of this study was to assess the outcomes of surgical and nonsurgical treatment modalities of MCP arthroplasty dislocations.
Of 816 MCP joint arthroplasties over a 14-year period, there were 37 (4%) acute MCP joint dislocations that required intervention by a health care professional. Implants involved included 28 nonconstrained implants including pyrocarbon (n = 17) and surface replacement arthroplasty (n = 11), and 9 silicone implants. The analysis included the treatment of dislocations after primary (n = 30) and revision (n = 7) MCP joint arthroplasty. Dislocation was defined as clinical and radiographic evidence of MCP joint prosthetic acute dislocation diagnosed and treated by a fellowship trained hand surgeon.
Etiologies underlying the dislocations included implant fracture (n = 6), component loosening (n = 2), and soft tissue deficiency (n = 29). Of the 37 dislocations, treatments included 14 nonsurgical (closed reduction, orthosis fabrication) all of which ultimately failed. Surgically, including some of the failed prior procedures, 18 soft tissue stabilization procedures and 21 revision arthroplasties were performed, with 6 that had failed soft tissue stabilization. The soft tissue stabilization procedures had a 28% success rate in achieving a stable MCP joint. Revision arthroplasty had a 71% success rate. Subgroup analysis showed an 86% success rate for silicone revisions and a 43% success rate with nonconstrained revisions, with 80% and 36% 5-year survival free of instability, for the 2 types of implants, respectively.
The treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
关于掌指关节（MCP）置换术后脱位的治疗结果，目前仍缺乏相关信息。本研究的目的是评估MCP置换术后脱位的手术和非手术治疗方式的结果。
在14年期间进行的816例MCP关节置换术中，有37例（4%）急性MCP关节脱位需要医护人员进行干预。涉及的植入物包括28例非限制性植入物，其中热解碳（n = 17）和表面置换关节成形术（n = 11），以及9例硅酮植入物。分析包括初次（n = 30）和翻修（n = 7）MCP关节置换术后脱位的治疗。脱位定义为经专科培训的手外科医生诊断和治疗的MCP关节假体急性脱位的临床和影像学证据。
脱位的病因包括植入物骨折（n = 6）、部件松动（n = 2）和软组织缺损（n = 29）。在37例脱位中，治疗方法包括14例非手术治疗（闭合复位、制作矫形器）但最终均失败。手术方面，包括一些先前失败的手术，进行了18例软组织稳定手术和21例翻修关节成形术，其中6例软组织稳定手术失败。软组织稳定手术使MCP关节达到稳定的成功率为28%；翻修关节成形术的成功率为71%。亚组分析显示，硅酮翻修的成功率为86%，非限制性翻修的成功率为43%，两种植入物5年无不稳定情况的生存率分别为80%和36%。
对于MCP关节置换术后脱位，翻修为硅酮植入物的治疗方法似乎最有希望在急性假体脱位后实现MCP关节的稳定。
研究类型/证据水平：治疗性IV级。
