The treatment of metacarpophalangeal destruction by rheumatoid arthritis is an indication
for arthroplasty, the swanson spacer is one of the options. The flexible silicone spacer may be implanted
with or without titanium guide sleeves ("grommets"). However, the imaginary abrasion protection
for the silicone grommets may in turn lead through micro-movements to wear. A 69 years old
female patient suffering from rheumatoid arthritis for 30 years is presented. 12 years ago swansen
spacers were implanted to metacarpo-phalangeal joints 2 -5 of the right hand. Due to pain, limited
movement and swelling at the volar MCP joints she presented at our clinic. Volar synovectomy of
the 3rd ray of the right hand was performed, the A2 ring band could be spared. There was massive
metallosis induced by wear of the grommets in the third volar tendon sheath, the other flexors were
free of metallosis. These results show that in synovitis after swanson spacer implantation using
grommets the differential diagnosis of metallosis must be included and complete synovectomy is the
treatment of choice.
Keywords: Metacarpophalangeal, metallosis, rheuma, silicone grommets, swanson, synovectomu.
Rights & PermissionsPrintExport