Schluttenhofer, Adam

Background: Metacarpophalangeal (MCP) arthroplasty is an established surgical option for end-stage MCP arthritis. We analyzed trends in case volumes and 30-day perioperative outcomes after MCP arthroplasty performed for rheumatoid arthritis (RA) and osteoarthritis (OA). Methods: We used the National Surgical Quality Improvement Program database to identify all MCP arthroplasties performed for RA (n = 216) or OA (n = 452) between 2010 and 2023. Bivariate analysis was used to compare patient demographics, operative characteristics, and 30-day outcomes. We analyzed temporal trends in case volumes using Poisson regression models and trends in patient characteristics using linear regression. Results: Patients with RA were more likely to be female (85% vs 54%) and have a history of smoking (22% vs 10%) and chronic steroid use (58% vs 4%). Patients with OA had more prevalent comorbidities including obesity, diabetes, and hypertension. Patients with RA more frequently required multi-joint replacement, concomitant soft tissue balancing procedures, plastic surgery involvement, and inpatient admission. The annual case volume for OA increased at +5.9% per year ( P < .001), whereas the volume for RA remained steady. The outpatient case volume grew at a rate of +4.6% per year ( P < .001). Both groups had similarly low rates of 30-day complications (0.9% RA, 1.8% OA), readmission (0.5% RA, 1.5% OA), and reoperation (0% RA, 0.9% OA). Conclusions: Despite distinct patient profiles and operative complexity, both OA and RA patients experience low rates of perioperative adverse events after MCP arthroplasty. Osteoarthritis is a growing indication for this procedure, which is increasingly being performed in the outpatient setting.

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.

Background: Use of pyrocarbon metacarpophalangeal (MCP) implants in rheumatoid arthritis (RA) patients has been associated with high rates of complications and reoperations. To date, few patient-specific prognostic factors have been identified. This study investigated body mass index (BMI) as a risk factor for RA patients undergoing pyrocarbon MCP arthroplasty. Methods: We included 148 joints (51 patients) that underwent pyrocarbon MCP implantation at our institution from 2000 to 2022. We analyzed survival free from revision, reoperation, and development of postoperative complications using cluster-robust Cox proportional hazard models with restricted cubic splines to plot non linear relationships. Secondarily, we compared survival above and below the World Health Organization cutoff for obesity of ≥ 30 kg/m 2 , adjusting for patient age and sex. Results: The relationship between BMI and risk for complications and revisions was J-shaped, with an increase in risk beyond 29 kg/m 2 . The relationship between BMI and late reoperations was U-shaped, with patients above 27.3 kg/m 2 and below 23.2 kg/m 2 at elevated risk. A BMI ≥ 30 kg/m 2 was associated with a 7.9-times increased risk for revision, 8.3-times increased risk for late reoperations, and 3.7-times increased risk for postoperative complications. Body mass index did not significantly influence risk for early reoperation. Conclusions: Body mass index was associated with pyrocarbon MCP implant failure in a non linear fashion, with overweight patients at risk for complications leading to revisions and late reoperations. Underweight patients may be at increased risk for late reoperations. These findings should inform patient and implant selection and help guide counseling for postoperative expectations.

Background: Pyrocarbon metacarpophalangeal (MCP) arthroplasty is associated with high rates of recurrent deformity and reoperation in patients with rheumatoid arthritis (RA). We sought to determine the impact of preoperative hand grip strength (HGS) on implant survivorship in these patients. Methods: We included primary pyrocarbon MCP arthroplasties in patients with RA at our single institution from 2000 to 2022. Cox proportional hazard models with restricted cubic splines were used to model the continuous relationship between HGS and hazard for revision, all-cause reoperation, and development of any complication, accounting for multiple joints per patient and adjusting for sex. Kaplan-Meier estimates were used to report survivorship at 2, 5, and 10 years. Results: We included 75 joints in 27 patients with an average preoperative HGS of 8.6 kg (11.1 years of follow-up). There were 16 (21%) total revisions, most commonly for recurrent deformity, along with 8 nonrevision reoperations, most commonly for tendon/ligamentous repair. There was a significant, J-shaped relationship between HGS and hazard for revision ( P = .001) and all-cause reoperation ( P < .001). Patients with HGS below 5.5 and 5.3 kg had an increased risk for revision (hazard ratio [HR]: 13.5) and all-cause reoperation (HR: 9.8) compared with patients with sufficiently high HGS. The 10-year revision survival was 93% in patients with HGS >5.5 kg and 63% in patients ≤5.5 kg. Hand grip strength did not significantly affect hazard for developing a first complication. Conclusion: Very low preoperative HGS is associated with worsened implant survivorship following pyrocarbon MCP arthroplasty in patients with RA.

Background/objectives: Falls are a leading cause of traumatic injury and hospitalization for adults over the age of 65. While common, bed-related falls are relatively understudied when compared to ambulatory falls. The aim of this study is to characterize the risk factors for the hospitalization of older adults presenting to U.S. emergency departments (EDs) after a fall from bed. Methods: This was a cross-sectional study using publicly available data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) from 2014 to 2023, including all adults over the age of 65 presenting to the NEISS’s participating EDs with bed-related fall injuries. We identified fall injuries using a keyword search of the NEISS narratives and determined how the fall occurred by manually reviewing a randomized 3% sample of the narratives. We summarized demographics and injury patterns with descriptive statistics. We constructed a multivariable logistic regression model to identify risk factors for hospitalization and used Poisson regression to assess temporal trends in fall incidence and hospital admissions. Results: An estimated average of 320,751 bed-related fall injuries presented to EDs annually from 2014 to 2023. ED visits increased by 2.85% per year, while hospital admissions rose by 5.67% per year (p < 0.001). The most common injury patterns were superficial injuries (contusions, abrasions, lacerations, avulsions, and punctures) (28.6%), fractures (21.7%), and internal injuries (including concussions) (21.6%). Most of the falls occurred while transitioning into or out of bed (34.4%) or falling out of bed (56.8%). Hospitalization was required in 34.1% of cases and was associated with male sex, medication use at time of injury, and fracture injuries. Conclusions: Bed-related falls and associated hospitalizations are increasing among older adults. ED providers should understand risk factors for hospitalization in these common injuries such as male sex, medication use at time of injury, and high-risk injury patterns. Additionally, prevention efforts should focus on helping older adults remain safely in bed and then assisting with transitions into or out of bed.