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Intraoperative periprosthetic fractures associated with metacarpophalangeal joint arthroplasty
Eric R Wagner1, Robert Van Demark1, Gregory A Wilson1
1Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN; Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Purpose:
To assess the incidence of and identify risk factors for intraoperative periprosthetic fractures during primary and revision metacarpophalangeal (MCP) joint arthroplasty.
Methods:
Through our institutional Joint Registry Database, we identified 818 MCP joint arthroplasties performed in 285 patients from 1998 to 2012, including 690 primary arthroplasties and 128 revision arthroplasties. Primary diagnoses included inflammatory arthritis (667), osteoarthritis (75), and posttraumatic arthritis (76). Periprosthetic fractures were identified through review of medical records.
Results:
Intraoperative periprosthetic fractures occurred in 23 (3%) fingers (21 patients), including 19 primary and 4 revision arthroplasties. Twelve fractures required stabilization, 4 required only bone grafting, and 1 required both. The fractures occurred during broaching (12), implantation (10), or prior implant removal (1). Diabetes mellitus (DM), younger age, pyrocarbon implant insertion, and cementless fixation increased risk for intraoperative fracture. In particular, DM and the use of pyrocarbon implants significantly increased fracture risk. At 4 years (range, 1.3-10.2 y) average follow-up, no patient with intraoperative fracture had developed a subsequent fracture compared with 3 postoperative fractures in patients without intraoperative fractures. All fractures had healed by the time of the last follow-up. The 2- and 5-year implant survival rates were 96% and 80% in those with intraoperative fractures, respectively, which was not significantly different from those without an intraoperative fracture. When comparing patients with an intraoperative fracture with those without, there was an increased risk of postoperative MCP joint instability defined as implant dislocation. Patients with intraoperative fractures still had noteworthy improvements in their postoperative pain levels and pinch strengths.
Conclusions:
Intraoperative fractures occurred in 3% of MCP joint arthroplasties, including 3% of primary and 3% of revision arthroplasties. Increased risk for fracture was associated with the use of pyrocarbon implants, cementless fixation, and DM. Although these fractures did not appear to adversely affect implant survival, they were associated with increased risk of postoperative instability.
Type Of Study/Level Of Evidence:
Prognostic III.
Insights
Intraoperative fractures occurred in 3% of metacarpophalangeal (MCP) joint arthroplasties. Diabetes mellitus and pyrocarbon implants significantly increased fracture risk, though implant survival was unaffected.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Rheumatology
Background:
- Metacarpophalangeal (MCP) joint arthroplasty is a common procedure for inflammatory, osteoarthritis, and posttraumatic arthritis.
- Intraoperative periprosthetic fractures are a potential complication during MCP joint arthroplasty.
- Identifying risk factors and outcomes associated with these fractures is crucial for surgical planning and patient management.
Purpose of the Study:
- To determine the incidence of intraoperative periprosthetic fractures during primary and revision MCP joint arthroplasty.
- To identify patient-specific and implant-related risk factors associated with these fractures.
- To evaluate the impact of intraoperative fractures on implant survival and postoperative outcomes.
Main Methods:
- A retrospective review of 818 MCP joint arthroplasties (690 primary, 128 revision) performed between 1998 and 2012 was conducted using an institutional Joint Registry Database.
- Patients' medical records were reviewed to identify intraoperative periprosthetic fractures.
- Statistical analysis was performed to identify risk factors and compare outcomes between patients with and without intraoperative fractures.
Main Results:
- Intraoperative periprosthetic fractures occurred in 3% of MCP joint arthroplasties (23 fractures in 21 patients).
- Risk factors for intraoperative fractures included diabetes mellitus (DM), younger age, pyrocarbon implant use, and cementless fixation, with DM and pyrocarbon implants showing significant association.
- While intraoperative fractures did not significantly impact implant survival rates at 2 and 5 years, they were associated with an increased risk of postoperative MCP joint instability (implant dislocation).
Conclusions:
- Intraoperative periprosthetic fractures are an infrequent but significant complication of MCP joint arthroplasty, occurring in 3% of cases.
- Diabetes mellitus and the use of pyrocarbon implants are key risk factors that necessitate careful consideration during surgical planning.
- Despite the increased risk of instability, intraoperative fractures did not compromise long-term implant survival and patients still experienced functional improvements.
