Metacarpophalangeal Joint Arthritis (2022)


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The Journal of Hand Surgery

Volume 36, Issue 2,

February 2011

, Pages 345-353

Arthritis of the metacarpophalangeal joint can result in considerable disability and pain. Inflammatory, posttraumatic, crystalline, and osteoarthritis are common etiologies of joint disease. A variety of nonsurgical treatment options have been shown to be effective, including activity modification, anti-inflammatory medications, splinting, and cortisone injections. In addition, newer generation disease-modifying antirheumatic drugs geared toward the treatment of rheumatoid arthritis have shown promise in retarding the inflammatory process. Another, relatively newer, conservative treatment option includes topical anti-inflammatories such as diclofenac sodium that are now approved by the Federal Drug Administration. Surgical treatment options most commonly include arthroplasty and arthrodesis. In the treatment of thumb metacarpophalangeal arthritis, arthrodesis is a popular and generally reliable surgical solution. In the fingers, arthroplasty remains the most common treatment option. Traditional constrained silicone joint replacements remain the most commonly used. Newer generation, unconstrained, surface replacement arthroplasties have shown promise in the treatment of osteoarthritis and select cases of inflammatory arthritis in which there is good bone stock, no or minimal deformity, adequate supporting soft tissues, and good disease control.

Section snippets

Clinical and Radiographic Evaluation

Patients with MCP arthritis typically present with pain, swelling, and limited motion of the MCP joint. Persons affected with rheumatoid arthritis (RA) will frequently have varying degrees of deformity. Typically, the fingers will deviate in an ulnar direction, and this deformity can also be driven by more proximal malalignment, such as radial deviation of the wrist. As the inflammatory disease progresses, the proximal phalanx will subluxate in a volar direction on the metacarpal head. The

Nonsurgical Treatment

Conservative treatment options for the management of osteoarthritis and inflammatory arthritis primarily include splinting, pharmacologic medications, and corticosteroid injections. There have been notable developments in the evolution of some of the pharmacologic treatments for RA over the past decade. Traditional disease-modifying antirheumatic drugs (DMARDs) such as oral corticosteroids, methotrexate, azathioprine, sulfasalazine, and leflunomide have been used for many years. A usual

Considerations Regarding Surgery

Surgery for MCP arthritis is an option for patients who have failed conservative measures. Persistent symptoms, synovitis, or swelling despite a 3- to 6-month course of nonsurgical interventions is viewed by most surgeons as an appropriate indication for surgery. Considerations for surgery, especially in patients with RA, require a thoughtful assessment of multiple factors such as nutritional status, comorbidities, pharmacologic disease control, infection risk, and the presence of cervical

(Video) Osteoarthritis of carpometacarpal Thumb joint

Surgery for the Thumb Metacarpophalangeal Joint

Surgical treatment of thumb MCP arthritis is less common than that of the trapezial-metacarpal joint. The most common surgical treatment of the arthritis thumb MCP joint remains arthrodesis. Most of the mobility of the thumb arises from the carpometacarpal joint; therefore, MCP arthrodesis is generally well tolerated. The optimal position of arthrodesis is typically 5° to 15° of flexion. It is important to examine and assess the carpometacarpal and interphalangeal joints for arthritis and range

Surgery for the Finger Metacarpophalangeal Joints

Arthroplasty is favored over arthrodesis for arthritis of the index through small finger MCP joints. Preserving some degree of flexion-extension and abduction-adduction of the digits not only helps function but also allows for better hygiene. However, MCP joint arthrodesis can reliably relieve pain. The etiology and activity of disease are important considerations in deciding the optimal arthroplasty treatment. Hinged silicone implants and newer-generation unconstrained surface replacement

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  • Cited by (41)

    • Management of the Metacarpophalangeal and Scaphotrapeziotrapezoidal Joints in Patients with Thumb Trapeziometacarpal Arthrosis

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    • Arthrodesis and Arthroplasty of the Small Joints

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      Arthritis of the small joints of the hand is a common problem encountered by orthopaedic hand surgeons. Nonoperative management is maximized to include splinting, injections, therapy in some situations, and oral analgesics. Pain is the main indication for joint arthroplasty and arthrodesis of the small joints of the hand. Additional indications include deformity, stiffness, and joint incongruity as seen in degenerative and inflammatory arthritis. We describe specific indications for treatment of the metacarpal phalangeal, finger proximal and distal interphalangeal, and thumb interphalangeal joints. Treatment options include open debridement of painful osteophytes, arthroplasty, and arthrodesis. Bone and soft-tissue stability is necessary to support an implant, thus treatment is dependent on the soft-tissue envelope and the amount of joint destruction. Based on the literature and the authors’ experience, arthrodesis is a better alternative than arthroplasty in most cases.

    • Joint Fusion and Arthroplasty in the Hand

      2019, Clinics in Plastic Surgery

      Unconstrained surface replacement arthroplasty for the MCP joint is indicated for patients with good bone stock and fewer deformities. Osteoarthritis rather than RA of the MCP joint can be a candidate for surface replacement arthroplasty.31 The PyroCarbon implant has an iso-elasticity to cortical bone with higher durability and biocompatibility.

    • Biomechanical analysis of metacarpophalangeal joint arthroplasty with metal-polyethylene implant: An in-vitro study

      2019, Clinical Biomechanics

      The most common implant options for the metacarpophalangeal joint arthroplasty include silicone, pyrocarbon and metal-polyethylene. A systematic review of outcomes of silicone and pyrocarbon implants was conducted; however, a similar exercise for metal-polyethylene implants revealed a scarcity of published results and lack of long-term follow-up studies. The aim of the present work is to test the hypothesis that the magnitude of metacarpophalangeal joint cyclic loads generates stress and strain behaviour, which leads to long-term reduced risk of metal-polyethylene component loosening.

      This study was performed using synthetic metacarpals and proximal phalanges to experimentally predict the cortex strain behaviour for both intact and implanted states. Finite element models were developed to assess the structural behaviour of cancellous-bone and metal-polyethylene components; these models were validated by comparing cortex strains predictions against the measurements.

      Cortex strains in the implanted metacarpophalangeal joint presented a significant reduction in relation to the intact joint; the exception was the dorsal side of the phalanx, which presents a significant strain increase. Cancellous-bone at proximal dorsal region of phalanx reveals a three to fourfold strain increase as compared to the intact condition.


      The use of metal-polyethylene implant changes the strain behaviour of the metacarpophalangeal joint yielding the risk of cancellous-bone fatigue failure due to overload in proximal phalanx; this risk is more important than the risk of bone-resorption due to the strain-shielding effect. By limiting the loads magnitude over the joint after arthroplasty, it may contribute to the prevention of implant loosening.

    • Outcomes Following Acute Metacarpophalangeal Joint Arthroplasty Dislocation: An Analysis of 37 Cases

      2018, Journal of Hand Surgery

      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.

      Therapeutic IV.

    • Nonrheumatoid Arthritis of the Hand

      2018, Journal of Hand Surgery

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      Arthralgia is treated by placement of an orthosis, analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroid injections. If nonoperative treatments are ineffective, arthroscopy, arthroplasty, and arthrodesis are options for treatment.12 In the case of unexplained isolated MCP arthritis involving the index or middle finger, hemochromatosis should be considered.

      Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid handarthropathies is beneficial for clinicians to recognize these problems.

    View all citing articles on Scopus

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      We did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Patients with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration were eligible. We randomly assigned (1:1) patients (permutated blocks of two and four by site) with an online web or third party telephone service to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. Patients and clinicians could not be masked to the intervention. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. We used intention-to-treat analysis, with multiple imputation for missing data, which was concealed to treatment group allocation. The trial is registered with the European Clinical Trials Database, number 2013-001435-48, and, number NCT02038452.

      Between April 17, 2014, and Dec 31, 2016, 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference −0·32; 95% CI −0·48 to −0·16; p=0·0001). No adverse events were reported.

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      Arthritis of the hand can result from inflammatory arthritis, osteoarthritis (OA), or be posttraumatic and can cause pain and debilitation. Arthroplasty serves as 1 surgical option in the surgical management of arthritis and aims to create a pain-free joint with preservation of motion. Although implant arthroplasty of the proximal interphalangeal (PIP), metacarpophalangeal (MCP), and trapeziometacarpal (TMC) joints predictably produce pain relief and high satisfaction, it has historically suffered from high rates of complications. The hinged silicone prosthesis was 1 of the early implants and, in many cases, remains the gold standard. However, problems with deformity correction, implant fracture, and synovitis remain. Implants made of alternative materials such asmetal-plastic and pyrocarbon have evolved; however, survivorship and reoperation rates remain a concern. This review details the evolution and current options available for small jointimplant arthroplasty involving the MCP, PIP, and TMC joints.

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    Copyright © 2011 Published by Elsevier Inc.

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