Abstract：Objective This work aims to summarize the current surgical treatment of severe metacarpophalangeal arthritis.Methods “掌指关节” “关节炎” “关节成形” “metacarpophalangeal joint” “arthritis” and “arthroplasty” were used as key words to identify articles about the surgical treatment of severe arthritis of the metacarpophalangeal joint. The articles searched in those published before December 2019 in CNKI, WanFang, and PubMed. A total of 1 322 articles were retrieved, among which 37 were included after excluding those with inconsistent content, inaccessible full text, and redundant topics.Results Arthrodesis, joint replacement, autologous joint transplantation, and autologous cartilage transplantation are the current surgical methods for the treatment of severe metacarpal arthritis. Different surgical methods have different indications. Arthrodesis can enhance the stability of the joints, but the loss of range of motion of the joints, can be used for the treatment of severe arthritis of the thumb. In joint replacement: (1) Swanson has strong stability in the body, and has a good effect on the improvement of finger pain and the range of motion of joints. However, the prosthesis is soft and has poor antiwear performance, with postoperative prosthesis fracture and joint range of motion, which can be used for the treatment of rheumatoid metacarpal arthritis. (2) Pyrolytic carbon prosthesis requires high stability of the bone and soft tissue around the joint, but the prosthesis has a good effect on the range of motion and appearance of the metacarpophalangeal joint and thus can be used for the treatment of severe osteo and traumatic metacarpophalangeal arthritis. (3) Self-locking finger joint prosthesis has good stability and anatomical similarity with human joints, but it is only used for the treatment of osteoarthritis and traumatic metacarpophalangeal arthritis. Autologous joint transplantation can achieve good stability and range of motion and avoid the complications of joint replacement; however, this technique has high requirements for microsurgical techniques. Autogenous cartilage grafts restore the range of motion in rigid joints by remodeling the metacarpophalangeal articular cartilage, but this procedure is only suitable for young patients with non-osteoarthritis and carries a risk of graft necrosis. The application of 3D printing technology can customize the prosthesis for patients with severe metacarpal arthritis, who lack appropriate prosthesis and eventually become disabled. This technology can also highly restore the bone anatomical structure and achieve the optimal match with the patient. However, 3D printing technology still suffers from some problems, such as immature technology, high printing cost, and complex process of fake systems.Conclusions For patients with severe metacarpophalangeal arthritis, different surgical treatment methods should be selected in accordance with the location, etiology, and condition of the affected limb. The improvement of existing surgical methods, joint prosthesis, and the application of 3D printing technology will be the future development direction of surgical treatment of severe metacarpophalangeal arthritis.
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Li Siyuan, Qin Yingjie, Ma Fei, Lu Yun. Surgical treatment of severe metacarpophalangeal joint arthritis. Chinese Journal of Anatomy and Clinics, 2021, 26(1): 109-114.
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2021, Vol. 26 
