Since the 1970s Swanson implant arthroplasty has become a treatment of choice in metacarpohalangeal (MCP) joint arthroplasty in destructed MCP joints of rheumatoid patients. Sutter (Avanta) implant is also composed of silicone but the centre of rotation is more anatomical, and volar to improve extension moment. Clinical results about these implants have been similar but fracture rates of Sutter implant have been reported to be high. Reason for osteolysis is inflammation reaction to silicone particles released from prostheses due to movement of prosthesis in bone or implant fractures. Reports about osteolysis around Swanson implants present variable result.

There is not grading of osteolysis in the literature before and we created a new radiographic grading for osteolysis around silicone MCP implants. Grading is based on involvement of cortical bone: Grade I: Osteolysis varying from a single clear line adjacent to the stem of the prosthesis to a larger, clear area which did not involve the bone cortex; Grade II: Osteolysis affecting the bone cortex to a maximum of one half of the thickness of the cortex; Grade III: Osteolysis affecting the cortex to more than one half of its thickness but not perforating the cortex; Grade IV: Osteolysis perforating the cortex.

In this study we compare the incidence of radiographic osteolysis following insertion of 89 Swanson and 126 Sutter MCP implants in rheumatoid arthritis patients. Before surgery hands were randomised one by one to Swanson and Sutter implant groups. The mean follow-up time in the two groups of patients was 57 (40–80) and 55 (36–79) months, respectively.

A total of 45 (60%) metacarpal and 40 (53%) proximal phalangeal bones showed no osteolytic changes in the Swanson group. In the Sutter group numbers were 20 (21%) and 26 (27%). In the Swanson group, there was less cortical osteolysis and there were 4 (5%) perforations of a metacarpal and no perforations of a proximal phalanx. In the Sutter group, there were 9 (9%) perforations in a metacarpal and 5 (5%) in a proximal phalanx. (p< 0.001). To create a single independent observation of osteolysis for a hand, the worst osteolysis of a metacarpal or proximal phalanx was recorded. There was only one (5%) perforation in the Swanson group, while there were 8 (30%) perforations in the Sutter group (p=0.011). In all grades of our classification, osteolysis was more frequent in the Sutter than in the Swanson group.

The purpose of the study was to evaluate the outcome of de la Caffinière prosthesis in the management of rheumatic destruction of the first carpometacarpal joint. By the end of 1998 the procedure was performed on 49 patients, 20 on the right hand and 29 on the left. All patients were addressed with a letter query and patient records and radiographs were assessed. Subjective contentment was measured with visual analog scale (VAS) and a questionnaire.

Thirty six of the patients had seropositive rheumatoid arthritis, 8 juvenile chronic arthritis and 5 other rheumatic variants. The mean follow-up was 8.6 (0.5–17) years. Subjective contentment was either excellent of good in 88% of the patients, and 75% were painfree.

Survival analysis with reoperation or significant loosening as end point was performed. Two cups loosened and one prosthesis was constantly dislocated, and these three were revised with tendon interposition technique. The survival rate was 96% (95% CI 84 to 99) at 5 years, and 92% (95% CI 77 to 97) at ten years.

Fairly good 10-year survival and encouraging subjective results have lead us to plan and start a clinical out-patient follow-up study to collect additional objective data on implant survival and function. Preliminary results of the new study yield superior range of motion compared to tendon interposition arthroplasty, which is the golden standard in our institute at the moment. However, we promote caution and emphasize the importance of patient selection since two additional revisions in our latter study may reveal a subgroup which is more prone to implant failure.

Aims: To study the survivorship of molded versus modular tibial component of the unconstrained anatomic graduated component (AGC; Biomet) prosthesis design.

Methods: We studied 794 knees of patients with rheumatoid arthritis operated 1985 – 1995 at the Rheumatism Foundation Hospital (=RFH), Heinola, Finland. Larsen score (=LS) of the preoperative radiographs was examined. Data was gathered from patient files and EULAR-database at RFH. A Kaplan-Meier survivorship analysis was performed with an endpoint of revision.

Results: We found no significant differences between survival of the molded (=group A)and the modular tibia (=group B) components. After 11 years cumulative success rate was 95% in A and 94,8% in the B group. The median follow-up was 7,95 years (group A 11,3, group B 7,4 years). 38 knees ended to an revision, and infection and pain were the main causes. Groups did not differ by LS or by demographic factors like age or weight. Fixation of the tibia or of the femur was also of no significance.

Conclusions: In our material there was no difference in the survival of two different designs of tibia component used in TKAs for patients with rheumatoid arthritis. Survival rates in both groups after 11 years follow-up can be considered promising.

Aims: The purpose of the study was to analyse the results of 4 primary and 21 revision total knee replacements performed on 24 patients with rheumatic disease using the Dual Articular Knee prosthesis with a mean follow-up of 2.3 (1–8) years. Methods: Patient documents and pre- and postoperative radiographs were evaluated with respect to radiolucent lines, fractures, lateral patellar displacement, proper resection lines, implant þt and behaviour of bone grafts as well as implant migration or subsidence during the follow-up. One to 8 years after the surgery, an interview of 22 patients was arranged to settle the subjective contentment, functional ability and the longevity of replaced knees. Results: Indication of primary TKR was þxed valgus in one knee and severe instability in 3, and in revision TKR aseptic loosening and instability in 15 knees, instability without implant loosening in 2 and infection in 4 knees. A 2-stage procedure was performed for infected arthroplasties with a mean period of cement interposition of 3 months. All the 2-stage exchange procedures healed without complications. Four patellar tendon avulsions and one deep infection were encountered. Results were excellent in 82% of patients. Conclusion: Dual Articular Knee proved to be favourable both in demanding primary and revision arhroplasties in patients with rheumatic disease.

Aims: To evaluate whether the atlantoaxial disorders (anterior atlantoaxial subluxation and atlantoaxial impaction) associate with destruction of shoulder or peripheral joints, and bone mineral density (BMD) in patients with long-term rheumatoid arthritis (RA). Methods: An inception cohort 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated. Results: A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of atlantoaxial disorders positively correlated with the grade of destruction in the evaluated joints. Furthermore, a positive relationship was found between the occurrence of the atlantoaxial disorders and a decrease in BMD of the femoral neck (p = 0.019). Conclusions: Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders, therefore the cervical spine radiographs of these patients should be analysed before major surgery and also at regular intervals. The co-existence of shoulder and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.