Objective. To determine the mechanisms responsible for the recurrence of ulnar drift after metacarpophalangeal joint arthroplasty in the rheumatoid hand.
Design. A three-dimensional biomechanical model of the index finger joints was used to predict the implant loads during several activities of daily living.
Background. Post-operative clinical evaluation of Sutter metacarpophalangeal prostheses shows a high incidence of fracture and recurrent deformity.
Methods. A six-component force transducer in conjunction with a six-camera motion analysis system were used to obtain kinematic and external loading data from eight patients with rheumatoid arthritis during several simulated activities. These data were used as input into a three-dimensional biomechanical model of the implant and interphalangeal joints of the index finger. Tendon lines of action and moment arms were obtained using a series of MRI scans and CAD modelling techniques.
Results. Implant forces were oriented in a radial and dorsal direction to resist the ulnarpalmarly pull of tendons associated with the metacarpophalangeal joint.
Conclusions. The recurrence of ulnar drift is attributable to fatigue failure of the prostheses. After fracture the implant is unable to support the repetitive loading patterns experienced during activities of daily living.
Relevance Understanding the mechanisms responsible for the recurrence of ulnar drift and implant failure is a step towards improving the prosthesis design, surgical procedures and ultimately the patient's prognosis.
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- Extensor digiti minimi tendon transfer to prevent recurrent ulnar drift.Plast. Reconstr. Surg. 1993; 92: 507-510
- The care of the arthritic hand.Quality Medical Publishing, inc, St Louis, Missouri1995
- Metacarpophalangeal joint prostheses. A review of the clinical results of past and current designs.J. Hand Surg. 1995; 20B: 125-136
- A prospective randomised comparison of Sutter and Swanson silastic spacers.J. Hand Surg. 1998; 23B: 574-577
- High implant fracture incidence with Sutter silicone metacarpophalangeal joint arthroplasty.J. Hand Surg. 1996; 21A: 813-818
- Finger joint force predictions related to design of joint replacements.J. Biomed. Eng. 1982; 4: 197-205
- Maximum finger force prediction using a planar simulation of the middle finger.J. Eng. Med.: Part H, Proc. Instn. Mech. Engrs. 1990; 204: 169-178
- A biomechanical model of index finger dynamics.Med. Eng. Phys. 1995; 17: 54-63
- Large index-fingertip forces are produced by subject-independent patterns of muscle excitation.J. Biomech. 1998; 31: 693-703
- Contribution of the extrinsic and intrinsic hand muscles to the moments in finger joints.Clini. Biomech. 2000; 15: 203-211
- A dynamic model for finger interphalangeal co-ordination.J. Biomech. 1988; 21: 459-468
- Functional and biomechanical assessment of the normal and rheumatoid hand.Clini. Biomech. 2001; 16: 660-666
Fowler NK, Nicol AC. A three dimensional biomechanical analysis of the metacarpophalangeal and interphalangeal joints of the index finger. XVIII Congress of International Society of Biomechanics, Zurich, 2001
- Method of determination of three dimensional index finger moment arms and tendon lines of action using high resolution MRI scans.J. Biomech. 2001; 34: 791-797
- An examination of one-piece metacarpophalangeal joint implants using finite element analysis.J. Med. Eng. Techol. 1996; 20: 145-150
- The interosseous muscles of the hand.J. Anatomy. 1936; 71: 395-403
- Pathomechanics and correction of the arthritic ulnar drift before and after cartilage destruction.in: Zancolli E.A. Structural and dynamic bases of hand surgery. JB Lippincott Co, Philadelphia1979: 325-367
- Mechanical properties of wrist extensor tendons are altered by the presence of rheumatoid arthritis.J. Orthop. Res. 1998; 16: 472-474
- Pre- and Postimplantation dynamic mechanical properties of Silastic HP-100 finger joints.J. Hand Surg. 1997; 22A: 299-301
- Computer model analysis of the Swanson and Sutter metacarpophalangeal joint implants.J. Hand Surg. 2000; 25B: 212-220
- Materials testing protocol for small joint prostheses.J. Biomed. Mater. Res. 1994; 28: 1209-1219
Fowler NK, Nicol AC. Long-term measurement of metacarpophalangeal joint motion in the normal and rheumatoid hand. J Eng Med: Part H, Proc Instn Mech Engrs 2001;21S:6;549–53
Accepted: April 2, 2002
Received: November 13, 2001
© 2002 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.