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指关节置换术（掌指关节，MCPJ） 资料 In-depth 知情同意

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

为何建议进行此手术

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会从适合您病情的最微创方案开始。患者通常由其全科医生转诊至我们的诊所；如果物理治疗师建议您就诊，您仍需获得全科医生的转诊才能符合 Medicare 报销资格。在您的预约就诊中，我们会采集病史、检查您的手部，并在必要时安排影像学检查。这能让我们了解关节内部的情况。

此手术用人工植入物替换掌指关节，即手指或拇指与手连接处的关节。通常，当关节面因关节炎而严重磨损，且其他治疗未能提供足够的缓解时，才会建议进行此手术。对于长期的磨损问题，我们通常先尝试非手术治疗：改变活动方式、物理治疗或手部治疗，以及支具固定。当这些措施未能提供足够的帮助时，才会考虑手术。手术的目的是缓解疼痛、改善功能，并保护邻近的关节。对于部分患者，它还能恢复已变得松动或变形的关节的稳定性。

术前

在手术前的几周内，我们会通过您手部的最新影像（如X光、MRI或超声）来确认手术方案。这些影像能显示磨损的关节，并帮助我们选择合适的植入物。您将获得关于禁食的明确指示：手术前七小时禁止进食和饮水。我们要求禁食七小时而非更短的时间，以便如果手术室排班提前，您的手术可以提前进行。某些药物需要在术前暂停，您的外科医生会告知您具体是哪些药物以及何时停用。如果您有其他健康状况，可能需要进行血液检查或接受麻醉医生的评估。手术当天，请携带您目前用药的清单，安排术后回家的接送，并穿着袖子宽松的舒适衣物。

手术当天

您抵达医院的手术入院单元，在此办理入院手续并做术前准备。您将与麻醉师见面，麻醉师负责在手术期间管理您的麻醉及疼痛控制。该手术在全身麻醉下进行。有时会追加区域神经阻滞以缓解术后疼痛；麻醉师将在当天就此与您讨论。随后，您将被带入手术室进行手术。

手术结束后，您将在复苏区苏醒。在麻醉作用消退期间，护士会全程监护您。待您的生命体征稳定后，根据手术类型及恢复情况，您将被转入病房或于当天出院。

手术内容

您的外科医生会在您的指关节背侧做一个小切口，以到达磨损的关节面。切除并修整受损的骨端，为植入物腾出空间。最常用的植入物是一种柔性间隔器，置于两块骨头之间，使关节能够再次弯曲，同时缓解疼痛。目标是减轻疼痛、改善活动度，并保护邻近的关节。

不同的植入物适用于不同的关节和不同的问题。对于某些患者，会使用柔软的硅胶间隔器。对于其他患者，特别是当周围韧带强壮且邻近手指提供支撑时，会选择形状类似自然关节面的较硬植入物。您的外科医生会选择适合您关节和病情的植入物。

植入物就位后，您的外科医生会检查手指是否对齐且活动顺畅，并平衡关节周围的软组织，以保持其稳定性。切口用缝合线关闭，并覆盖敷料。敷料保留约10天，这在“术后”部分有详细说明。

对于某些拇指指关节，将骨头连接在一起（融合术）是植入物的替代方案。这消除了疼痛的关节，但意味着拇指的一部分不再弯曲。在签署知情同意书之前，您的外科医生会与您讨论哪种方案适合您的关节。

术后

您将在复苏室醒来，随着麻醉药效消退，护士会密切观察您的情况。您的手部将包裹在厚重的敷料中，我们会为您提供镇痛治疗以确保您的舒适。回家后，最初的24小时内应有人陪伴您。您可以正常活动，但请保持轻松，坐着时将手抬高放在枕头上休息。您的医疗团队会告知您是当天回家还是住院一晚。敷料通常保留约10天；除非我们告知您，否则请勿在此之前拆除。我们会在复诊时为您更换或拆除敷料。

恢复

在最初几天，您的手部会感到疼痛和肿胀，指关节可能会感觉僵硬和压痛。将手抬高放在枕头上休息可以减轻肿胀，我们提供的止痛药可让您保持舒适。随着关节愈合，不适感会逐渐消退。

起初，您的手部会包裹着厚实的敷料，敷料大约保留10天。复诊时，我们会更换或拆除敷料，并检查皮肤愈合情况。此手术后的康复由Extend康复中心的Ruby Doolan提供手部治疗。她将指导您进行锻炼，并在必要时为您制作支具。这些锻炼旨在保护新关节，同时让您的手指或拇指恢复活动度，并会向您展示如何在日常生活中使用手部而不使其过度受力。

随着肿胀消退，弯曲和伸直通常感觉更轻松。一旦您能够无痛地抓握和捏取，您会发现穿衣、进食和书写等日常活动变得更加自然。许多人注意到，主要的获益是术前疼痛的缓解，以及手部在日常任务中使用的改善。

当您的手部佩戴支具或正在服用强效止痛药时，您不应驾驶，并且您需要能够用双手握住方向盘并在紧急制动时做出反应。我们关于上肢手术后驾驶的单独指南解释了何时可以安全返回驾驶。

恢复情况因人而异，您的时间表可能有所不同。我们将在每次复诊时，连同您的手部治疗师一起为您提供指导。

可能出现的并发症

大多数患者恢复良好，但偶尔也可能出现问题。您的外科医生和医疗团队会密切监测您的状况，以便尽早发现任何问题。

此类关节置换术后感染并不常见。请留意伤口周围的皮肤。如果您发现伤口周围发红扩散、局部发热、渗液，或出现用普通止痛药无法缓解的深层搏动性疼痛，请立即联系诊所。如果您感到发热或身体不适，请前往急诊科。

新植入的关节有时会脱位。这被称为脱位。您可能会感到关节突然移位，手指或拇指停留在异常角度且无法正常活动。如果发生这种情况，请立即致电诊所。

植入物本身可能会随时间推移而磨损、松动、开裂或弯曲。迹象包括已缓解的疼痛复发、出现新的弹响或摩擦感，或手指偏离正常轴线。请在下次复诊时告知医生这些变化，如果症状突然发作，则应提前致电。

植入物周围的骨骼也可能在手术过程中发生骨折。外科医生会在您离开手术室前检查这一点，通常通过缩短夹板保护期即可愈合。

如果确实出现问题，有时需要进一步手术来修复。这可能意味着再次更换植入物；或者，如果置换不适合，则将该关节的骨骼融合在一起，使其愈合为一个坚固的整体。第二种选择可以消除疼痛，但会阻止关节弯曲。如果真到了那一步，您的外科医生会解释哪种方案适合您的具体情况。

一些患者在手术后可能会注意到手指或拇指持续僵硬或无力。手部治疗对此有帮助，因此请在复诊时提及，而不是等待。

如果您想了解具体数据，本页上的并发症表列出了典型的发病率。

何时联系我们

大多数问题会在最初几周内出现，因此了解需要警惕的症状非常重要。如果您注意到伤口周围发红扩散、渗液、发热或疼痛持续加重，请致电我们。如果您感到发热不适，或小腿出现肿胀和压痛，请前往急诊。突发呼吸困难也需要急诊处理。如果您的手指或拇指突然移位、处于异常角度或无法活动，请立即致电我们。不缓解的麻木或刺痛感也需要及时检查。如有疑问，请致电我们。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您做出自身治疗决策所需的深度。指间关节置换值得额外阅读，原因在于一个有趣的现象：当今最常用的植入物本质上仍是20世纪60年代引入的设计，其使用寿命超过了所有旨在取代它的材料。理解其原因有助于阐明该手术的实际目的。

硅胶假体未发生移位

2026年关于类风湿关节炎掌指关节置换术的综述得出结论：该手术在类风湿手的管理中仍发挥着核心作用，并且尽管植入物技术取得了进步，柔性硅胶关节置换术在适当筛选的患者中仍能带来可靠的功能和外观改善 [1]。

六十年的材料科学发展已催生了金属-塑料和碳素复合材料等替代方案，而硅胶间隔物仍是参考标准。这在关节置换领域是不寻常的，因为在同一时期，髋关节和膝关节植入物一直在持续迭代。

原因在于，该植入物并未执行其名称所暗示的功能。它并非通过重塑关节面来恢复承重功能，而是一个柔性间隔物，用于维持间隙，并在瘢痕组织围绕其形成新关节囊的过程中充当内部夹板。最终效果是由愈合过程而非器械本身提供的，这就是为什么更好的承重表面从未转化为更好的临床结果。

结果的真实总结

对指关节和拇指关节植入物关节置换术的综述明确指出：植入物关节置换术可预期地带来疼痛缓解和高满意度，但历史上并发症发生率较高；尽管金属-塑料和碳素材料已不断演进，假体存活率和再手术率仍令人担忧 [2]。

两方面都至关重要。患者对这些手术普遍感到满意，疼痛消失，外观改善，手部在日常活动中的功能得到提升，且植入物具有有限的寿命，存在实际的再手术率。满意度与耐久性是两个不同的问题，而该手术在前者上的表现远优于后者。

对于骨关节炎，证据较为薄弱

大多数文献关注类风湿关节炎，因为在该病中，需要矫正的畸形最为显著。对于骨关节炎，情况则较弱：现有证据由样本量较小且随访时间相对较短的回顾性队列研究组成[3]。

值得注意的是，当作者在对骨关节炎的治疗中倾向于选择碳素而非硅胶时，其依据是潜在的改善稳定性和对位的可能性，且相关数据被描述为初步结果[3]。这是一个合理的立场，但应将其视为基于机制的推理，而非基于已证实的优越性。

耐久性正成为一个更受关注的问题

近二十年前提出的担忧非但未消解，反而日益凸显：随着预期寿命的延长，以及这些手术越来越多地应用于更年轻、活动量更大的患者（他们将更长时间地承受假体负荷）[4]，假体的耐久性变得愈发重要。对于一款十年表现可接受的假体而言，其在75岁患者中的应用前景与在55岁患者中的应用前景截然不同。

从实践角度看，这要求我们明确手术旨在实现的目标。对于旨在缓解疼痛、矫正畸形并改善手部功能，且手部机械负荷要求适中的情况，这是一种证据充分、拥有长期临床记录的手术。然而，若将其作为用于数十年重负荷使用的持久性重建手段，则并非如此。

参考文献

[1] Herren DB. Balancing metacarpophalangeal joint arthroplasty in rheumatoid arthritis. J Hand Surg Eur Vol. 2026;51(6):778-84. https://doi.org/10.1177/17531934261430139

[2] Srnec JJ, Wagner ER, Rizzo M. Implant arthroplasty for proximal interphalangeal, metacarpophalangeal, and trapeziometacarpal joint degeneration. J Hand Surg Am. 2017;42(10):817-25. https://doi.org/10.1016/j.jhsa.2017.07.030

[3] Martin AS, Awan HM. Metacarpophalangeal arthroplasty for osteoarthritis. J Hand Surg Am. 2015;40(9):1871-2. https://doi.org/10.1016/j.jhsa.2015.05.019

[4] Goldfarb CA, Dovan TT. Rheumatoid arthritis: silicone metacarpophalangeal joint arthroplasty indications, technique, and outcomes. Hand Clin. 2006;22(2):177-82. https://doi.org/10.1016/j.hcl.2006.02.001

Reviewed by Dr Kieran Hirpara · 13 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • MCP joint arthroplasty was performed safely in the setting of acute complex open MCP joint trauma [1].
  • Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years [2].
  • Revision MCP arthroplasty has a relatively high rate of postoperative dislocations [2].
  • Dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years [3].
  • 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 [4].
  • MCP joint arthroplasty is an effective treatment option from a patient-centered perspective, improving appearance, pain, and function [5].
  • Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief and correction of deformity [6].
  • Patient satisfaction with Silastic interposition arthroplasty of the MCPJ is high despite only modest improvements in the objective assessment of hand function [6].
  • The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in OA patients [8].
  • Periprosthetic joint infection is uncommon after MCP or PIP arthroplasties [9].
  • Patient expectations of MCP joint arthroplasty were uniformly high, with functional improvement being the greatest motivation for surgery [11].
  • Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty and facilitating realistic expectations [14].
  • Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction [24].
  • Implant arthroplasty of the PIP, MCP, and TMC joints has historically suffered from high rates of complications [24].
  • The evidence regarding MCP arthroplasty for OA consists of retrospective cohorts with small sample sizes and relatively short evaluations [26].

Anatomy & Pathophysiology

Joint Mechanics and Kinematics

  • The metacarpophalangeal joint allows hyperextension up to approximately 20° [17].
  • Radial and ulnar deviation at the metacarpophalangeal joint decreases with flexion due to the associated tightening of the collateral ligaments [17].
  • Volar and proximal translation of the proximal phalanx is observed on 4-dimensional computed tomography following silicone implant arthroplasty [48].

Bony and Ligamentous Anatomy

  • The metacarpophalangeal articulations serve as the keystones of the longitudinal arches of the hand [39].
  • The thick anterior glenoid capsules, known as volar plates, prevent hyperextension at the metacarpophalangeal joints [39].
  • The volar plates are interconnected by the transverse interglenoid ligament [39].
  • The stability of the metacarpophalangeal joints is essential to the support of both the longitudinal arch and the transverse metacarpal arch [39].
  • The deep transverse intermetacarpal ligament, also named the interglenoid ligament, ties together the anterior glenoid ligaments of the metacarpophalangeal articulations [39].
  • The lateral accessory ligaments, sagittal bands of the extensor apparatus, and the first annular segment of the flexor tendon pulley insert on the volar plate [39].

Muscular Anatomy

  • The deep head of each dorsal interosseous muscle forms a lateral tendon, or lateral band, at the level of the metacarpophalangeal joint [36].
  • The deep head of the dorsal interosseous muscles flexes and weakly abducts the proximal phalanx while extending the middle and distal phalanges [36].
  • Transverse fibers arch dorsally from each lateral band to join over the dorsum of the finger, flexing the proximal phalanx [36].
  • Oblique fibers from the lateral bands sweep over the distal third of the proximal phalanx to insert onto the lateral tubercles at the base of the middle phalanx [36].
  • The oblique fibers extend the middle phalanx at the proximal interphalangeal joint [36].
  • The lateral bands are joined by the lateral slips of the extensor tendon to form the conjoined lateral band [36].
  • The two conjoined lateral bands to each finger unite at the distal third of the middle phalanx to form the terminal tendon [36].
  • The terminal tendon inserts at the base of the distal phalanx to extend it [36].
  • The volar interossei form the ulnar lateral band of the index finger and the radial lateral band of the ring and little fingers [36].
  • The flexor digiti quinti brevis forms the ulnar lateral band of the little finger [36].

Pathophysiology

  • Rheumatoid arthritis is a chronic, progressive, systemic inflammatory disease that affects multiple organ systems, including the musculoskeletal system [17].
  • The inflammatory process in rheumatoid arthritis is triggered and perpetuated by a cascade of mediators that result in synovial proliferation, collagenous destruction of the cartilage and soft tissues, and bone resorption [17].
  • The metacarpophalangeal joint is the most common site of involvement in the rheumatoid hand [17].
  • The metacarpophalangeal and proximal interphalangeal joints of the hand are typically involved early in rheumatoid arthritis [17].

Classification

  • Silicone rubber implants are the most frequently used device for treatment of revised metacarpophalangeal arthroplasty [17].
  • The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in osteoarthritis patients [8].
  • Pyrocarbon implants were designed as a resurfacing implant for the MCP joint [28].
  • A radiographic classification system was modified to differentiate stable implant migration patterns (grade 2) from unstable patterns (grade 3) based on cortical breach status [28].
  • In a radiographic analysis of 37 pyrocarbon arthroplasties, 34 (92%) were determined to be stable at last follow-up [28].
  • Three (7%) pyrocarbon implants became unstable from migration, all involving grade 3 implant loosening [28].
  • Evidence of implant subsidence greater than 1 mm occurred in 6 (16%) of 37 pyrocarbon implants [28].
  • Postoperative ulnar deviation greater than 10° occurred in 8 (22%) fingers following pyrocarbon arthroplasty [28].
  • Implant fractures in silicone MCP arthroplasty are determined based on criteria including lucent lines, fragmentation, translation greater than one-half the diameter of the bone, and dislocation defined as proximodistal overlap more than one-half the width of the midportion of the implant [20].
  • Coronal plane deviation greater than 45° is an additional criterion for determining implant fracture or instability in silicone MCP arthroplasty [20].

Clinical Presentation

Indications and Etiology

  • Metacarpophalangeal joint arthroplasty is most often performed in patients with rheumatoid arthritis, although it is occasionally performed for joints affected by osteoarthritis [17].
  • Dorsal capsule interpositional arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ [3].
  • Metacarpophalangeal joint arthroplasty continues to play a central role in the management of the rheumatoid hand [15].

Patient Expectations and Motivation

Functional Outcomes and Range of Motion

  • Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief and correction of deformity, and patient satisfaction is high despite only modest improvements in the objective assessment of hand function [6].
  • Pain ratings and MCP arc of motion significantly improved following arthroplasty for noninflammatory arthritis [10].
  • Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction but has historically suffered from high rates of complications [24].
  • This study showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction in patients undergoing MCP arthroplasty for nonrheumatic arthritis [30].
  • Swanson arthroplasty frequently results in a range of flexion of the MP joint of the little finger that may be insufficient for its principal functions [19].

Complications and Complications Management

  • Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations [2].
  • 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 [4].
  • Increasing MCP joint flexion range was associated with increased fractures of the implants in silicone metacarpophalangeal joint arthroplasty for patients with rheumatoid arthritis [7].
  • If squeaking is associated with pain and swelling, revision MCP joint arthroplasty is recommended to identify and correct the underlying cause, such as implant subsidence or an incongruous joint [53].
  • An articulating spacer allows movement of the joint and reduces the chance of immobilisation associated complications such as bone loss, joint stiffness, and soft tissue contracture in the management of infected MCPJ arthroplasties [13].

Investigations

  • A careful physical examination is essential to direct care and future testing if indicated [27].
  • Diagnostic tests such as imaging and serum laboratory studies are useful in determining pathology but can be expensive, time consuming, and often nonspecific [27].

Treatment

Indications and Patient Expectations

  • MCP joint arthroplasty is most often performed in patients with rheumatoid arthritis, though it is occasionally performed for osteoarthritis [17].
  • The MCP joint is the most common site of involvement in the rheumatoid hand [17].
  • MCP joint arthroplasty continues to play a central role in the management of the rheumatoid hand [15].
  • Given improvements in the medical management of rheumatoid disease, the indications for and long-term expectations of silicone metacarpophalangeal arthroplasty must be carefully examined [50].

Implant Types and Outcomes

  • Both NeuFlex and Swanson implant groups obtained satisfactory clinical improvement after MCP reconstruction of the hand [12].
  • Pain ratings and MCP arc of motion significantly improved following surface replacement arthroplasty in metacarpophalangeal joints affected by noninflammatory arthritis [10].
  • Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients undergoing pyrocarbon metacarpophalangeal joint arthroplasty for noninflammatory arthritis [31].
  • Silicone arthroplasty for nonrheumatic metacarpophalangeal joint arthritis showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction [30].
  • Follow-up studies show that MCP arthroplasty improves function and deformity and achieves nearly uniform patient satisfaction [17].

Alternative Techniques

  • Limited clinical follow-up in a perichondrium transplant group showed reasonably good, and in some cases excellent, results several decades after the surgery, especially at the MCP level [16].
  • Arthrodesis has been the gold standard in treating isolated end-stage MP arthritis, whether inflammatory or post-traumatic arthropathies [32].
  • Arthrodesis is able to provide effective pain relief as well as restore stability to the joint, even in the setting of severe arthritis [32].
  • The key to why MP fusion in the thumb is so successful lies in the relatively negligible loss of motion that results from MP fusion [32].
  • By fusing the MP joint between 20 and 40° of flexion, stress can be relieved from the CMC joint by minimizing the activity required at the CMC for thumb opposition [32].

Complications and Revision

  • Metallosis is a potential long-term complication of grommets in silicone MCP joint arthroplasty, and given the lack of documented benefit from grommets, the authors recommend against their use [52].
  • Static spacers with consequent immobilisation can lead to bone loss, joint stiffness and soft tissue contracture, often causing significant complications at reimplantation [13].
  • An articulating spacer allows movement of the joint and reduces the chance of immobilisation associated complications [13].
  • An articulated spacer technique can be considered as an option to maintain motion while treating infected MCPJ arthroplasties and the co-morbidity resulting from immobilisation of the whole hand [13].

Specific Clinical Scenarios

Complications

Dislocation and Instability

  • Revision MCP arthroplasty is associated with a relatively high rate of postoperative dislocations [2].
  • Treatment of acute MCP joint arthroplasty dislocation with revision to a silicone implant appears to hold the most promise in achieving a stable MCP joint [4].
  • In a cohort of 37 cases, acute prosthetic dislocation was managed with revision surgery [4].

Implant Fracture and Failure

  • One in five patients undergoing revision MCP arthroplasty required a revision procedure at 5 years [2].
  • Increasing MCP joint flexion range was associated with increased fractures of silicone implants in patients with rheumatoid arthritis [7].
  • In a longitudinal analysis of 325 cases, implant fractures were determined based on criteria including lucent lines, fragmentation, translation greater than one-half the diameter of the bone, and dislocation defined as proximodistal overlap more than one-half the width of the midportion of the implant [20].
  • In a study of 40 silicone implants for MCP osteoarthritis, radiographs demonstrated fractured implants in 5 of 40 (12.5%) implants, although none of these patients had clinical instability, pain, or deterioration in range of motion [33].
  • For the Neuflex silicone implant, survivorship at 7 years was 88% when revision was the end point, but dropped to 68% when implant fracture was the end point [56].
  • In a study of pyrocarbon arthroplasty for rheumatoid arthritis, complication and overall reoperation rates were high, with 1 in 10 patients undergoing revision within 5 years postoperatively [57].
  • Patients with greater hand function preoperatively may be at higher risk of revision surgery after silicone MCP arthroplasty for inflammatory arthritis [18].

Infection

  • Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [9].
  • Management of infected MCP joint replacements can involve removing the prosthesis and inserting gentamycin-loaded bone cement balls for 3 weeks before a final exchange operation [13].
  • Static spacers used in MCPJ infection management can lead to bone loss, joint stiffness, and soft tissue contracture, often causing significant complications at reimplantation [13].
  • An articulating spacer allows movement of the joint and reduces the chance of immobilization-associated complications compared to static spacers [13].

Other Complications

  • Intraoperative periprosthetic fractures are associated with metacarpophalangeal joint arthroplasty [21].
  • Swanson arthroplasty frequently results in a range of flexion of the MCP joint of the little finger that may be insufficient for its principal functions [19].
  • In a study of pyrocarbon arthroplasty for osteoarthritis, postoperative ulnar deviation greater than 10° occurred in 8 (22%) fingers [28].
  • In a study of pyrocarbon arthroplasty for osteoarthritis, 3 (7%) implants became unstable from migration, all with grade 3 implant loosening [28].
  • Evidence of implant subsidence greater than 1 mm occurred in 6 (16%) of 37 pyrocarbon implants, but no implants studied at more than 1 year after surgery demonstrated progressive subsidence resulting in implant instability [28].
  • Implant arthroplasty of the MCP joint has historically suffered from high rates of complications [24].

Recovery

Functional Outcomes and Patient Satisfaction

  • MCP joint arthroplasty improves appearance, pain, and function from a patient-centered perspective [5].
  • Silastic interposition arthroplasty of the MCPJ is reliable for pain relief and correction of deformity [6].
  • Patient satisfaction is high following Silastic interposition arthroplasty despite only modest improvements in the objective assessment of hand function [6].
  • The HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint demonstrates satisfactory short- to mid-term outcomes with considerable improvements in pain relief and joint mobility [59].

Complications and Revision

Patient Expectations and Indications

Specialized Scenarios

Key Evidence

  • [L4] MCP joint arthroplasty was performed safely in the setting of acute complex open MCP joint trauma. [1] (10.1016/j.jhsa.2015.09.012)
  • [L4] Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations. [2] (10.5435/jaaos-d-17-00042)
  • [L4] This technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years. [3] (10.1177/1558944720911215)
  • [L4] 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. [4] (10.1016/j.jhsa.2017.10.001)
  • [L4] MCP joint arthroplasty is an effective treatment option from a patient-centered perspective, improving appearance, pain, and function. [5] (10.1016/j.hcl.2006.02.001)
  • [L4] Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief and correction of deformity, and patient satisfaction is high despite only modest improvements in the objective assessment of hand function. [6] (10.1054/jhsb.2000.0402)
  • [L4] Increasing MCP joint flexion range was associated with increased fractures of the implants. [7] (10.1016/j.jhsa.2020.09.002)
  • [L5] The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in OA patients. [8] (10.1016/j.jhsa.2012.11.025)
  • [L4] PJI is uncommon after MCP or PIP arthroplasties. [9] (10.1016/j.jhsa.2024.12.008)
  • [L4] Pain ratings and MCP arc of motion significantly improved following arthroplasty. [10] (10.1177/15589447211028917)
  • [L1] Patient expectations of MCP joint arthroplasty were uniformly high, with functional improvement being the greatest motivation for surgery. [11] (10.1016/j.jhsa.2011.02.002)
  • [L1] Both implant groups obtained satisfactory clinical improvement after MCP reconstruction of the hand. [12] (10.1016/j.jhsa.2009.09.020)
  • [L5] [13] (10.1177/17531934251323067)
  • [L4] Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty and facilitating realistic expectations. [14] (10.1002/msc.1061)
  • [L5] Metacarpophalangeal joint arthroplasty continues to play a central role in the management of the rheumatoid hand. [15] (10.1177/17531934261430139)
  • [L3] [16] (10.1186/s12891-020-03687-3)
  • [L5] [17] (10.5435/00124635-200305000-00005)
  • [L3] Patients with greater hand function preoperatively may be at higher risk of revision surgery. [18] (10.1177/1558944719831236)
  • [L4] Our experience with this cohort, a review of published literature, and a survey of international experts suggest that Swanson arthroplasty frequently results in a range of flexion of the MP joint of the little finger that may be insufficient for its principal functions. [19] (10.1007/s11552-007-9051-5)
  • [L4] [20] (10.1177/1753193418778461)
  • [L3] [21] (10.1016/j.jhsa.2014.12.038)
  • [L4] Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction but has historically suffered from high rates of complications. [24] (10.1016/j.jhsa.2017.07.030)
  • [L4] The evidence regarding MCP arthroplasty for OA consists of retrospective cohorts with small sample sizes and relatively short evaluations. [26] (10.1016/j.jhsa.2015.05.019)
  • [L4] [28] (10.1016/j.jhsa.2022.08.013)
  • [L3] This study showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction in patients undergoing MCP arthroplasty for nonrheumatic arthritis. [30] (10.1016/j.jhsa.2013.09.016)
  • [L4] Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients. [31] (10.1016/j.jhsa.2015.06.104)
  • [L5] [32] (10.1016/j.hcl.2006.02.010)
  • [L4] [33] (10.1016/j.jhsa.2017.10.010)
  • [L4] Volar and proximal translation of the proximal phalange was observed on 4-dimensional computed tomography. [48] (10.1016/j.jhsa.2021.10.001)
  • [L4] Given these findings, the indications for and long-term expectations of silicone metacarpophalangeal arthroplasty must be carefully examined in light of the improvements in the medical management of rheumatoid disease. [50] (10.2106/00004623-200310000-00001)
  • [Case_report] Metallosis is a potential long-term complication of grommets in silicone MCP joint arthroplasty, and given the lack of documented benefit from grommets, the authors recommend against their use. [52] (10.1007/s11552-012-9401-9)
  • [L5] If squeaking is associated with pain and swelling, revision MCP joint arthroplasty is recommended to identify and correct the underlying cause, such as implant subsidence or an incongruous joint. [53] (10.1016/j.jhsg.2022.10.002)
  • [L4] [56] (10.1177/1753193408094437)
  • [L4] Complication and overall reoperation rates were high, while 1 in 10 undergo revision within 5 years postoperatively. [57] (10.1177/15589447211063577)
  • [L4] The HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint demonstrates satisfactory short- to mid-term outcomes, with considerable improvements in pain relief and joint mobility. [59] (10.1016/j.jhsg.2025.100804)

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[10] Outcomes of Surface Replacement Arthroplasty in Metacarpophalangeal Joints Affected by Noninflammatory Arthritis. HAND. 2021. DOI: 10.1177/15589447211028917

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