Metacarpophalangeal Joint Arthroplasty in Juvenile Idiopathic Arthritis: A Case Series

Juvenile idiopathic arthritis (JIA) is an inflammatory arthritis of childhood that can lead to pain and dysfunction of the hands. In severe progressive cases, in which medical treatment does not result in symptom improvement, limited options are available. Metacarpophalangeal (MCP) joint arthroplasty remains a standard surgical treatment for inflammatory arthritis of the MCPmetacarpophalangeal joints in adults; however, no reports exist about its use in children or for JIA.

We present two cases of MCP joint arthroplasty in patients with severe progressive JIA. The first patient presented at 21 years old with increasing pain and limited use of her right hand and underwent MCP arthroplasty using a pyrocarbon implant. The second patient presented at 14 years old with severe pain, contractures, subluxations, and the inability to use her right hand, subsequently undergoing MCP replacement with a silicone-based implant. The joint replacements resulted in pain relief and improvement of hand function for both patients, though the pyrocarbon implants had poor radiographic outcomes at 7 years follow- up, while the silicone implants had limited functional improvement.

MCPMetacarpophalangeal joint replacement may be considered in patients with severe inflammatory arthritis to relieve pain and/or to extend functional use of the fingers and hands. In these cases, silicone arthroplasty radiographically fared better than pyrocarbon.