Resection arthroplasty for luxation of the manubrio-sternal joint in rheumatoid arthritis—a case report

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. DOI 10.3109/17453674.2010.480940 In 2001, we saw a 54-year-old woman with destructive seronegative rheumatoid arthritis (RA). Because of secondary osteoarthritis, she had received a replacement of the right hip and of both knees, and a triple arthrodesis of the right foot. Furthermore, she had chronic obstructive pulmonary disease (COPD) and bronchiectasia. She complained of severe pain and a sensation of heavy pressure at the site of the manubrio-sternal joint (MSJ), which had developed at the beginning of 2000, making coughing very difficult. She had a tender swelling at the same location on the sternum and we saw a dorsal dislocation of the manubrium. A severe thoracic kyphosis was also observed. A radiograph and CT showed a luxation of the MSJ (Figure). The patient also required a hemiarthroplasty of the left shoulder, so we planned to perform an arthrodesis of the MSJ in the same session. Hemiarthroplasty of the left shoulder was first performed and then the arthrodesis of the sternum was started. However, during this procedure, on trying to place the manubrium back into position, we observed that there would still be a bone gap of about 1 cm and too much tension on the manubrium. We decided, therefore, to do a resection arthroplasty. Approximately 1 cm of the manubrium and 1 cm of the sternum was resected and the gap was closed by the soft tissue layers, which had been displaced. The skin was closed and a deep drain was left in. During the first 2 years after surgery, she had no pain or sensation of pressure on the sternum, and the swelling had almost disappeared. She could sit in a more relaxed position, which made coughing easier. Later on, the swelling slowly progressed but the patient still did not experience any pain. At 7 years, physical examination revealed an eminent swelling of the sternum but without any tenderness. The patient was very satisfied with the result. Radiography showed that the sternum was positioned 4 cm anteriorly to the manubrium.