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A number of patients with silicone rubber implants performed by us and other surgeons
initially had excellent results; however, they returned with swelling and discomfort.
We studied 18 patients ranging in age from 16 years to 57 years who presented 8 to
78 months (average, 31.7 months) after silicone arthroplasty (four scaphoid, six lunate,
one scapholunate, four finger, two wrist, one trapezium, and one ulnar head for metacarpal
hemiarthroplasty). Erosive osteolysis was seen on x-ray films, with progressive destruction
evident in patients followed serially. None of the patients' conditions responded
to conservative care. The severity of the proliferative, inflammatory synovitis and
the foreign material in the multinucleated giant cells correlated with the interval
since arthroplasty. Implant surface analysis by scanning electron microscope and x-ray
spectrometer showed that silicone microparticles were the result of implant degeneration
and erosion. All joint cultures were negative. Silicone particulate synovitis and
destruction were arrested by the removal of the implant, a synovectomy, and curettage
of the lytic lesions at salvage (resection arthroplasty or arthrodesis.) Patients
who have had silicone arthroplasties should be followed indefinitely, at regular intervals,
by x-ray films and clinical examination.
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Article info
Publication history
Accepted:
January 8,
1986
Received:
July 24,
1985
Identification
Copyright
© 1986 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
