Balancing metacarpophalangeal joint arthroplasty in rheumatoid arthritis.

BACKGROUND: Metacarpophalangeal joint destruction in rheumatoid arthritis leads to pain, deformity, impaired function and poor cosmesis. Arthroplasty remains a principal reconstructive option for restoring alignment and improving function.

METHODS: This narrative review summarizes the current concepts of metacarpophalangeal joint arthroplasty in patients with rheumatoid arthritis. The historical evolution of surgical techniques and implant designs is outlined, with particular emphasis on flexible silicone implants, which remain the most widely used option. Indications, contraindications, implant alternatives and key aspects of surgical technique and rehabilitation are discussed. Reported clinical outcomes, complications, and long-term implant survival are reviewed.

RESULTS: Flexible silicone implants remain the most widely used prostheses and remain the best performing. They offer reproducible correction of ulnar drift and volar subluxation, with consistent improvements in hand alignment, function and appearance. Alternative implants, including surface-replacement and pyrocarbon prostheses, aim to replicate joint anatomy but have shown less predictable results in the rheumatoid setting, largely due to soft-tissue insufficiency. Across all implant types, outcomes are closely linked to surgical technique, particularly soft-tissue balancing, tendon realignment and management of associated deformities. Complications include recurrent deformity, limited motion, implant fracture and infection, although long-term patient satisfaction is generally high.

CONCLUSIONS: Metacarpophalangeal joint arthroplasty continues to play a central role in the management of the rheumatoid hand. Despite advances in implant technology, flexible silicone arthroplasty provides reliable functional and cosmetic improvement in appropriately selected patients. Durable outcomes depend on reconstruction of the soft tissues, correction of associated deformities and rehabilitation, rather than implant design alone.

LEVEL OF EVIDENCE: V.