Purpose
To compare postoperative range of motion (ROM) and function in a randomized prospective
trial of Swanson and NeuFlex metacarpophalangeal (MCP) joint implants.
Methods
A total of 33 patients who had rheumatoid arthritis underwent primary MCP arthroplasty
of all 4 fingers in 40 hands; 20 received Swanson implants and 20 received NeuFlex
implants. Exclusion criteria included diagnosis of other connective tissue disorders
and previous MCP joint surgery. All participants followed the same postoperative rehabilitation
protocol. The primary outcome measure was active MCP flexion. Secondary outcomes included
active MCP extension, arc of motion, ulnar drift, function (Jamar grip strength and
Sollerman hand function test), and the Michigan Hand Questionnaire. Patients were
assessed preoperatively and 12 months postoperatively.
Results
Patients' mean age was 62.5 years (Swanson) and 58.1 years (NeuFlex) (p = .03). A
total of 19 of 20 hands (Swanson) and 14 of 20 hands (NeuFlex) were from female patients.
Preoperative active ROM was not significantly different. At follow-up, both groups
demonstrated increased active extension and arc of motion (p < .001), reduced active
flexion and improved ulnar deviation (p < .001), increased mean Sollerman and Michigan
Hand Questionnaire domain scores (p < .001), and improved grip strength (p = .03).
Active MCP flexion was significantly greater in all 4 digits of hands with NeuFlex
implants compared with Swanson implants. The NeuFlex group demonstrated a greater
total arc of motion in the little finger. Implant groups were not significantly different
by individual digit for active MCP extension, ulnar drift, and composite flexion.
Functional outcomes did not differ between groups. Patients with Swanson implants
reported higher Michigan Hand Questionnaire scores in the function and aesthetics
domains.
Conclusions
Both implant groups obtained satisfactory clinical improvement after MCP reconstruction
of the hand. The NeuFlex group demonstrated superior ROM, whereas the Swanson group
had better self-reported function and aesthetics, but not objectively measured function.
Type of study/level of evidence
Therapeutic I.
Key words
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Article info
Publication history
Accepted:
September 30,
2009
Received:
February 11,
2009
Footnotes
DePuy Orthopaedics, Inc. (Canada), a Johnson & Johnson company, provided an unrestricted research grant and implants used for this study. Wright Medical Technology provided implants for this study.
Identification
Copyright
© 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
