A prospective outcomes study of Swanson metacarpophalangeal joint arthroplasty for the rheumatoid hand

Purpose: Destruction and dislocation of the metacarpophalangeal (MCP) joints are common occurrences in patients with rheumatoid arthritis (RA). Disruption of the support ligaments around the MCP joints and ulnar deviation of the fingers affect hand function and hamper the ability to perform activities of daily living. A common surgical intervention is the Swanson Metacarpophalangeal Joint Arthroplasty (SMPA), which restores alignment of the fingers. Methods: We conducted a prospective study with 16 patients to determine outcomes of this procedure. We present our data from the 6-month and 1-year follow-up periods. Results: Functional assessment by grip strength, pinch strength, and Jebsen-Taylor Test did not improve significantly when compared with preoperative values. Subjective assessment by the Michigan Hand Outcomes Questionnaire (MHQ), however, did improve significantly. Large improvements were seen in the function, activities of daily living, aesthetics, and patient satisfaction domains, with preoperative to 1-year postoperative score improvements of 26, 42, 57, and 43 points, respectively, based on a 100-point scale. Ulnar drift significantly decreased 1 year after surgery by an average of 24degrees and MCP joint range of motion increased, but this change was not significant. Conclusions: Our data show that patients with RA who underwent SMPA had significant improvements in patient-reported outcomes at the 1-year interval. Continued follow-up evaluation of this cohort will determine whether these improvements are maintained in the long term. Copyright (C) 2004 by the American Society for Surgery of the Hand.