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Small Joint Implants and Arthrodesis: Hand and Toes
B.J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Small implants may be used to replace bone or joints in hands or feet
          • Variety of materials used; may have metal components but most are a variety of silicon
          • "Silastic" = silicon for purposes of this discussion
          • Carpal or other small implants are formed in shape of structure to be replaced [scaphoid, lunate, temporomandibular joint (TMJ) meniscus, base of 1st metacarpal (MC)/metatarsal (MT)]
          • Swanson arthroplasty: Silastic arthroplasty utilized for MCP, metatarsophalangeal (MTP), or interphalangeal (IP) joints of hand or feet
            • Other varieties (i.e., Sutter arthroplasty) are not distinguished here since appearance and complications are similar
            • Rectangular body with triangular flanges or stems extending into diaphyses of phalanges or MC/MT
            • Stems are usually not cemented within diaphyses, and there is no ingrowth potential
            • "Hinge" at site of joint is thinning of Silastic between body of prosthesis and its stem; at risk for fracture
            • May have metal grommets: Theoretical but not demonstrated protection against stem fracture

      IMAGING

      • Radiographic Findings

        • MR Findings

          • Imaging Recommendations

            DIFFERENTIAL DIAGNOSIS

              PATHOLOGY

              • General Features

                • Gross Pathologic & Surgical Features

                  • Microscopic Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Gaspar MP et al: Management of complications of wrist arthroplasty and wrist fusion. Hand Clin. 31(2):277-292, 2015
                              2. Satteson ES et al: The management of complications of small joint arthrodesis and arthroplasty. Hand Clin. 31(2):243-266, 2015
                              3. Adkinson JM et al: Advances in small joint arthroplasty of the hand. Plast Reconstr Surg. 134(6):1260-8, 2014
                              4. Petscavage JM et al: Imaging assessment of the postoperative arthritic wrist. Radiographics. 31(6):1637-50, 2011
                              5. Petscavage JM et al: Arthroplasty of the hand: radiographic outcomes of pyrolytic carbon proximal interphalangeal and metacarpophalangeal joint replacements. AJR Am J Roentgenol. 197(5):1177-81, 2011
                              6. Sullivan MR: Hallux rigidus: MTP implant arthroplasty. Foot Ankle Clin. 14(1):33-42, 2009
                              7. Earp BE: Treatment of advanced CMC joint disease: trapeziectomy and implant arthroplasty (silastic-metal-synthetic allograft). Hand Clin. 24(3):277-83, vi, 2008
                              8. Ferreira JN et al: Evaluation of surgically retrieved temporomandibular joint alloplastic implants: pilot study. J Oral Maxillofac Surg. 66(6):1112-24, 2008
                              9. Naidu SH: Oxidation of silicone elastomer finger joints. J Hand Surg Am. 32(2):190-3, 2007
                              10. Parkkila TJ et al: Survival and complications are similar after Swanson and Sutter implant replacement of metacarpophalangeal joints in patients with rheumatoid arthritis. Scand J Plast Reconstr Surg Hand Surg. 40(1):49-53, 2006
                              11. Amadio PC: A comparison of fusion, trapeziectomy, and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Br. 30(3):331-2; author reply 332, 2005
                              12. Miller D et al: Free gracilis interposition arthroplasty for severe hallux rigidus. Bull Hosp Jt Dis. 62(3-4):121-4, 2005
                              13. Parkkila TJ et al: Grading of radiographic osteolytic changes after silastic metacarpophalangeal arthroplasty and a prospective trial of osteolysis following use of Swanson and Sutter prostheses. J Hand Surg Br. 30(4):382-7, 2005
                              14. Taylor EJ et al: A comparison of fusion, trapeziectomy and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Br. 30(1):45-9, 2005
                              15. Trail IA et al: Seventeen-year survivorship analysis of silastic metacarpophalangeal joint replacement . J Bone Joint Surg Br. 86(7):1002-6, 2004
                              16. Joyce TJ et al: A literature review of "failures" of the Swanson finger prosthesis in the metacarpophalangeal joint. Hand Surg. 7(1):139-46, 2002
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  TERMINOLOGY

                                  • Definitions

                                    • Small implants may be used to replace bone or joints in hands or feet
                                      • Variety of materials used; may have metal components but most are a variety of silicon
                                      • "Silastic" = silicon for purposes of this discussion
                                      • Carpal or other small implants are formed in shape of structure to be replaced [scaphoid, lunate, temporomandibular joint (TMJ) meniscus, base of 1st metacarpal (MC)/metatarsal (MT)]
                                      • Swanson arthroplasty: Silastic arthroplasty utilized for MCP, metatarsophalangeal (MTP), or interphalangeal (IP) joints of hand or feet
                                        • Other varieties (i.e., Sutter arthroplasty) are not distinguished here since appearance and complications are similar
                                        • Rectangular body with triangular flanges or stems extending into diaphyses of phalanges or MC/MT
                                        • Stems are usually not cemented within diaphyses, and there is no ingrowth potential
                                        • "Hinge" at site of joint is thinning of Silastic between body of prosthesis and its stem; at risk for fracture
                                        • May have metal grommets: Theoretical but not demonstrated protection against stem fracture

                                  IMAGING

                                  • Radiographic Findings

                                    • MR Findings

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          PATHOLOGY

                                          • General Features

                                            • Gross Pathologic & Surgical Features

                                              • Microscopic Features

                                                CLINICAL ISSUES

                                                • Presentation

                                                  • Demographics

                                                    • Natural History & Prognosis

                                                      • Treatment

                                                        DIAGNOSTIC CHECKLIST

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Gaspar MP et al: Management of complications of wrist arthroplasty and wrist fusion. Hand Clin. 31(2):277-292, 2015
                                                          2. Satteson ES et al: The management of complications of small joint arthrodesis and arthroplasty. Hand Clin. 31(2):243-266, 2015
                                                          3. Adkinson JM et al: Advances in small joint arthroplasty of the hand. Plast Reconstr Surg. 134(6):1260-8, 2014
                                                          4. Petscavage JM et al: Imaging assessment of the postoperative arthritic wrist. Radiographics. 31(6):1637-50, 2011
                                                          5. Petscavage JM et al: Arthroplasty of the hand: radiographic outcomes of pyrolytic carbon proximal interphalangeal and metacarpophalangeal joint replacements. AJR Am J Roentgenol. 197(5):1177-81, 2011
                                                          6. Sullivan MR: Hallux rigidus: MTP implant arthroplasty. Foot Ankle Clin. 14(1):33-42, 2009
                                                          7. Earp BE: Treatment of advanced CMC joint disease: trapeziectomy and implant arthroplasty (silastic-metal-synthetic allograft). Hand Clin. 24(3):277-83, vi, 2008
                                                          8. Ferreira JN et al: Evaluation of surgically retrieved temporomandibular joint alloplastic implants: pilot study. J Oral Maxillofac Surg. 66(6):1112-24, 2008
                                                          9. Naidu SH: Oxidation of silicone elastomer finger joints. J Hand Surg Am. 32(2):190-3, 2007
                                                          10. Parkkila TJ et al: Survival and complications are similar after Swanson and Sutter implant replacement of metacarpophalangeal joints in patients with rheumatoid arthritis. Scand J Plast Reconstr Surg Hand Surg. 40(1):49-53, 2006
                                                          11. Amadio PC: A comparison of fusion, trapeziectomy, and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Br. 30(3):331-2; author reply 332, 2005
                                                          12. Miller D et al: Free gracilis interposition arthroplasty for severe hallux rigidus. Bull Hosp Jt Dis. 62(3-4):121-4, 2005
                                                          13. Parkkila TJ et al: Grading of radiographic osteolytic changes after silastic metacarpophalangeal arthroplasty and a prospective trial of osteolysis following use of Swanson and Sutter prostheses. J Hand Surg Br. 30(4):382-7, 2005
                                                          14. Taylor EJ et al: A comparison of fusion, trapeziectomy and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Br. 30(1):45-9, 2005
                                                          15. Trail IA et al: Seventeen-year survivorship analysis of silastic metacarpophalangeal joint replacement . J Bone Joint Surg Br. 86(7):1002-6, 2004
                                                          16. Joyce TJ et al: A literature review of "failures" of the Swanson finger prosthesis in the metacarpophalangeal joint. Hand Surg. 7(1):139-46, 2002