Bankes, Audrey

Background: Little is known about how silicone metacarpophalangeal (MCP) arthroplasty outcomes compare between rheumatoid arthritis (RA) and osteoarthritis (OA) patients. Methods: Using our single institutional data from 2000 to 2022, we propensity matched 46 primary silicone MCP arthroplasties in 33 OA patients 1:2 to 92 arthroplasties in 54 RA patients based on age, sex, body mass index, operative digit, and if the surgery was on the dominant hand. We used Kaplan-Meier estimates and cluster-robust Cox proportional hazard models to compare survival free from revision, all-cause reoperation, and development of coronal plane deviation >10°. Results: There was comparable 10-year survival free of revision (94% OA, 91% RA) and all-cause reoperation (91% OA, 87% RA), with no difference in risk for each outcome between groups. Revision in OA patients occurred early (mean 0.6 years) for recurrent deformity (n = 2) and periprosthetic joint infection (n = 1). Revision in the RA cohort occurred later (mean 6.3 years postoperatively) for recurrent deformity (n = 3) and dislocation (n = 1). Osteoarthritis patients had less coronal plane deviation at the final radiographic follow-up (6.5° vs 16.2°, P < .001), higher 10-year survival free from coronal deviation > 10° (79% vs 17%), and lower risk of progressive coronal deformity (hazard ratio 0.15, P < .001). Conclusions: Silicone MCP arthroplasty remains a durable option with low reoperation rates for RA and OA. Osteoarthritis patients experience less coronal deviation and late reoperation for deformity than RA patients, likely due to their more robust soft-tissue stabilizers and noninflammatory disease process.

Background: Anti-cyclic citrullinated peptide antibodies (ACPAs) are associated with more aggressive rheumatoid arthritis disease. We aimed to determine the effect of ACPA serostatus on survival free from revision, all-cause reoperation, and recurrence of coronal plane deformity in patients with rheumatoid arthritis (RA) undergoing silicone metacarpophalangeal (MCP) arthroplasty. Methods: We retrospectively identified silicone MCP arthroplasties performed in patients with RA with known ACPA serostatus from 2000 to 2022. Kaplan-Meier estimates were used to report survival free from revision, all-cause reoperation, and recurrence of coronal plane deviation >10° on postoperative radiographs. We analyzed ACPA serostatus as a risk factor for these endpoints using cluster-robust Cox proportional hazard models, adjusting for patient sex. Results: We included 133 joints in 39 ACPA seropositive patients (9.0 years mean follow-up) and 63 joints in 21 ACPA seronegative patients (5.7 years mean follow-up). Survival free from revision, all-cause reoperation, and recurrent coronal deformity was higher in seropositive patients than in seronegative patients. Anti-cyclic citrullinated peptide antibody seropositivity was significantly associated with lower risk for revision (hazard ratio [HR] = 0.16), all-cause reoperation (HR = 0.20), and recurrent coronal plane deviation >10° (HR = 0.28). Seropositive patients had longer average time to recurrent coronal deviation >10° (3.5 years vs 1.3 years) and less coronal deviation at final radiographic follow-up (15.9° vs 21.5°). Conclusions: Anti-cyclic citrullinated peptide antibody seropositivity is associated with improved silicone MCP implant survivorship and lower risk of recurrent coronal plane deformity in patients with rheumatoid arthritis. More work is needed to better understand the biologic basis of these findings.