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Reconstruction of finger joints using autologous rib perichondrium: an observational study at a single Centre with a median follow-up of 37 years
Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Orthopedics, Falu Lasarett, Falun, Sweden.
Örebro University, School of Medical Sciences. University Hospital, Örebro, Sweden; Division of Pediatric Endocrinology and Center of Molecular Medicine, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden.ORCID iD: 0000-0002-9986-8138
Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University Hospital, Entrence 70 1 floor, 751 85, Uppsala, Sweden; Elisabeth Hospital Aleris, Uppsala, Sweden.
2020 (English)In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 21, no 1, article id 278Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Gratifying long-term results are difficult to achieve when reconstructing osteoarthritic finger joints. Implant surgery is the most commonly used method to restore function and dexterity. However, all types of implant have disadvantages and may be a less favorable option in some cases, especially in young patients with a long expected lifetime and high demands on manual load. Implant related complications as loosening, instability, subsidence and stiffness are the main concerns. In this context, joint reconstruction using rib perichondrium might be a reasonable alternative in selected cases. The aim of the study was to evaluate the long-term results of finger joint reconstruction using rib perichondrial transplantation.

METHODS: The study group (n = 11) consisted of eight individuals reconstructed in the proximal interphalangeal (PIP) joints and three reconstructed in the metacarpophalangeal (MCP) joints during 1974-1981. All patients were evaluated at clinical visits (median: 37 years after perichondrial transplantation, range: 34-41 years) using radiographs, disability in arm-shoulder-hand (DASH) score, Visual Analog Scale (VAS), range-of-motion (ROM) and manual strength (JAMAR).

RESULTS: None of the 11 patients had undergone additional surgery. All of the PIP-joints (n = 8) were almost pain-free at activity (VAS 0,6) (range 0-4), had an average range-of-motion of 41 degrees (range 5-80) and a mean DASH-score of 8,3 (range 1-51). The mean strength was 41 kg compared to 44 kg in the contralateral hand (93%). The three MCP joints were almost pain-free at activity (VAS 0,7), (range 0-1). The ROM was on average 80 degrees (range 70-90) and the mean DASH-score was 2 (range 1-3). The mean strength was 43 kg compared to 53 kg in the contralateral hand (81%).

CONCLUSIONS: Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. Additional studies are needed to evaluate long-term results in comparison to modern implants and to better describe the factors that determine the outcome of these procedures.

LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Place, publisher, year, edition, pages
BioMed Central, 2020. Vol. 21, no 1, article id 278
Keywords [en]
Articular cartilage, Joint reconstruction, Perichondrium, Transplantation
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-81450DOI: 10.1186/s12891-020-03310-5ISI: 000531327700002PubMedID: 32349740Scopus ID: 2-s2.0-85084169917OAI: oai:DiVA.org:oru-81450DiVA, id: diva2:1428528
Funder
Swedish Research Council, K2015-54X-22 736-01-4 2015-02227Vinnova, 201401438Marianne and Marcus Wallenberg FoundationStockholm County CouncilSwedish Society of MedicineNovo NordiskThe Karolinska Institutet's Research Foundation
Note

Funding Agency:

Uppsala County Council

Byggmästare Olle Engkvist Stiftelse

Erik och Edith Fernström Foundation for Medical Research  

HKH Kronprinsessan Lovisas förening for barnasjukvård 

Sällskapet Barnavård

Stiftelsen Frimurare Barnhuset i Stockholm

Nyckelfonden

Örebro University, Orebro, Sweden  

Uppsala University 

Available from: 2020-05-05 Created: 2020-05-05 Last updated: 2024-01-17Bibliographically approved

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