Journal of Hand Surgery European - 2026-03-21 - Journal Article; Review
Balancing metacarpophalangeal joint arthroplasty in rheumatoid arthritis.
Herren DB
Topics
Key Takeaway
Flexible silicone MCP arthroplasty outperforms surface-replacement and pyrocarbon alternatives in the rheumatoid hand, with durable outcomes driven by soft-tissue balancing rather than implant design.
Summary Depth
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Summary
This narrative review evaluates current concepts in MCP arthroplasty for rheumatoid arthritis, comparing flexible silicone implants against surface-replacement and pyrocarbon alternatives. Silicone implants provide reproducible correction of ulnar drift and volar subluxation with consistently high patient satisfaction. Alternative implants show less predictable results due to soft-tissue insufficiency inherent to the rheumatoid hand, and outcomes across all implant types depend primarily on soft-tissue reconstruction and tendon realignment.
Key Limitation
As a narrative review without systematic search criteria or quantitative synthesis, conclusions about comparative implant performance are not supported by pooled effect sizes or risk-of-bias assessment.
Original Abstract
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.