Results of metacarpophalangeal joint surgery in patients with Rheumatoid arthritis
Synovitis of the MCP joints ultimately leads to joint destruction, MCP subluxation, and ulnar deviation of the fingers. There is little evidence that prophylactic synovectomy slows joint destruction, but it may postpone the need for joint replacement surgery when done early before x-ray changes. MCP arthroplasty is indicated when synovitis has resulted in cartilage destruction, decreased motion, pain, ulnar drift, deformity, and loss of function. MCP arthroplasties, irrespective of design, result in 50 degrees of motion which may decrease to 30 degrees over time. Ulnar deviation can be improved to <20 degrees. Postoperative splinting and hand rehabilitation are critical for optimal results. Arthrodesis is not done except for the thumb MCP joint. This is because the thumb needs strength for pinch, whereas motion is less important.