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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Boutonniere deformity of the rheumatoid thumb – Radiographic evaluation of Swanson hinge toe implant arthroplasty

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  • presenting/speaker Tetsuya Nemoto - Showa University, Shinagawa-ku, Tokyo, Japan
  • Hajime Ishikawa - Niigata Rheumatic Center, Shibata, Japan
  • Issaku Toyohara - Niigata Rheumatic Center, Shibata, Japan
  • Asami Abe - Niigata Rheumatic Center, Shibata, Japan
  • Hiroshi Otani - Niigata Rheumatic Center, Shibata, Japan
  • Katsunori Inagaki - Showa University, Shinagawa-ku, Tokyo, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1846

doi: 10.3205/19ifssh0227, urn:nbn:de:0183-19ifssh02270

Published: February 6, 2020

© 2020 Nemoto et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The boutonniere deformity of the thumb is the most common deformity of rheumatoid thumb. Metacarpophalangeal(MP) joint arthroplasty is indicated for the deteriorated MP joint with preserved soft tissue stability. Feldon introduced to use flexible hinge toe implant for the MP joint reconstruction because of its better mechanical strength compared to finger joint implant. We hypothesized rheumatoid thumb reconstruction using flexible hinge toe implant would improve the clinical outcomes and radiological findings.

Methods: Swanson implant arthroplasty for at the thumb MP joint was performed on the 108 cases (male 11, female 97) between 1986 and 2014 with minimum follow up of 6 months. The average age was 61 yrs. old and the average follow-up period was 4 yrs. The duration of the rheumatoid arthritis at the time of surgery was 22 years. Combined with this MP joint arthroplasty, arthrodesis at the IP joint in 26 cases, capsulodesis at the IP joint in 4 cases, suspensionplasty at the CM joint (Thompson) was performed in one case. Radiological assessments were performed and MP flexion angle and IP extension angle were measured. Extension loss at MP joint was divided into 4 groups: normal (less than 5 degree), mild (5 to 19 degree), moderate (20 to 39 degree) and severe (40 and more degree).

Results and Conclusions: In the radiological assessment, the pre- and the postoperative flexion angles at the MP joint were 42 and 17 degrees, and extension angles at the IP joint were 37 and 0 degree(s). Preoperative severity was mild in 15 cases, moderate in 36 cases and severe in 56 case. Postoperative severity was improved to normal in 9 cases, mild in 50 cases, moderate in 44 cases and severe in 3 cases. In one case, postoperative infection occurred and implant was removal of required. 3 cases of implant fracture occurred and revision was performed in 2 cases and removal was performed in 1 case with a synovitis. Swanson implant with a grommets did not cause implant fracture.

By the rheumatoid thumb surgery, deformity was corrected. The ratio of implant failure was lower than that in the previous reports.