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A Comparative Study of Short-Term Outcomes Between INTEGRA and AVANTA Silicone Implants for Metacarpophalangeal
Shuichi Naniwa1, Keiichiro Nishida2, Yoshihisa Nasu3
1Department of Orthopaedic Surgery, Section of Medicine, Division of Medicine, Dentistry and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Kita-ku, Okayama, Japan.
Purpose:
To compare the short-term clinical outcomes and fracture rate of the silicone implants AVANTA and INTEGRA for metacarpophalangeal (MCP) joint arthroplasty in patients with rheumatoid arthritis (RA).
Methods:
The current single center retrospective cohort study included consecutive RA cases who underwent MCP joint arthroplasty for the index through little fingers between August 2017 and July 2023. After exclusions, the data from 184 fingers of 58 patients (AVANTA, 96 fingers of 28 patients; INTEGRA, 88 fingers of 30 patients) were analyzed. Outcomes of MCP joint arc of motion, extension range, flexion range, ulnar deviation, grip and pinch strength, Disabilities of the Arm, Shoulder, and Hand disability/symptom (DASH d/s) score, and Hand20 score were assessed preoperatively, at 1 year, and at 2-5 years. The primary analysis was performed using mixed-effects models incorporating patient-level clustering and adjustment for baseline differences. Radiographs at each time point were reviewed for implant fracture.
Results:
Both implants yielded improvements in arc of motion, extension range, flexion range, and ulnar deviation postoperatively with no significant differences. Grip strength improved in both groups, with significantly greater gains in the INTEGRA group. Pinch strength improved at 1 year in the INTEGRA group. In the INTEGRA group, DASH d/s score and Hand20 score was better than AVANTA at final follow-up. During follow-up, implant fractures occurred in 11.5% of the AVANTA group and none in the INTEGRA group, resulting in a survival rate of 77.1% for AVANTA and 100% for INTEGRA patients at 5 years after surgery.
Conclusions:
Both AVANTA and INTEGRA silicone MCP arthroplasty improved arc of motion and finger alignment in patients with RA. INTEGRA showed advantages in greater grip strength, earlier pinch strength, DASH d/s score, and Hand20 score. No implant fractures were observed in the INTEGRA group during the study period.
Type Of Study/Level Of Evidence:
Prognosis IV.