Jonelle Marie Petscavage MD, MPH, Presenter: Nothing to Disclose

Alice S. Ha MD, Abstract Co-Author: Nothing to Disclose

Felix Sze-Kway Chew MD, Abstract Co-Author: Nothing to Disclose

The radiographic outcomes of replacements of the proximal interphalangeal (PIP), metacarpophalangeal (MCP), and carpometacarpal (CMC) joints have scarcely been described. Our aim was to describe the short and long-term radiographic features of pyrocarbon implants in the hand, determine the most common types of complications, and assess for risk factors associated with complications.

This retrospective study had IRB approval. Medical records were searched over a 10-year period for patients who received pyrocarbon implants of the PIP, MCP, or CMC joints. All available hand radiographs were reviewed and correlated with contemporaneous clinical information. Statistical analysis included calculation of complication rate, logistic regression for variable association with complication, Chi-Square Test for symptoms and radiographic findings, and Kaplan Meier survival analysis.

Total of 56 implants in 44 patients were found. Mean follow-up was 15.7 months (range 1 to 82). There were 30 PIP implants, 17 MCP implants, and 9 CMC implants. Mean age was 56 years (range 22-77). Indication for arthroplasty was osteoarthritis in 62.5%, trauma in 23.25%, and inflammatory arthritis in 10.7%. In 13 cases, a second surgery was performed, 5 for retrieval and 8 for revision. Complications seen on radiographs included volar tilt (17.9%), malposition due to loosening (16.1%), periprosthetic fracture (5.3%), heterotopic bone (5.3%), subluxation (5.3%), and osteolysis (3.5%). There was no statistical association (r < 0.001) between 2 mm (or less) of symmetric lucency around the distal implant with future complications. Radiographic findings and patient symptoms were unrelated (p < 0.5).

Almost one quarter of implants required surgical revision or retrieval. Volar tilt of the proximal stem and subsidence are the more common complications. Periprosthetic lucency of 2 mm (or less) around the distal stems is normal.

This study will help radiologists recognize normal short and long term appearances of PIP, MCP, and CMC pyrocarbon arthroplasty and associated common complications.

Petscavage, J, Ha, A, Chew, F, Arthroplasty of the Hand: Radiographic Outcomes of PIP, MCP, and CMC Joint Replacements.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008826.html