Surface replacing arthroplasty of a post-traumatic stiff and deviated proximal interphalangeal joint in an adolescent.

This case report describes the 4-year outcomes of proximal interphalangeal joint arthroplasty in a 14-year-old girl with a stiff joint after trauma. At follow-up, active range of motion was 35°, she was pain-free and satisfied with the outcome. Implant arthroplasty seems to be a valuable option for young patients with persistent post-traumatic stiff and deviated PIP joints to-at least temporarily-increase quality of life.

Long-Term Implant Fracture Rates Following Silicone Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis.

PURPOSE: The primary objective of this study was to compare the long-term survival rates of silicone metacarpophalangeal (MCP) arthroplasties between two major implants in patients with rheumatoid arthritis, using implant fracture as an end point. We also evaluated the difference in postoperative function between patients with fractured and intact implants as a secondary objective. METHODS: A retrospective cohort study was conducted on 372 fingers of 133 hands that underwent silicone MCP arthroplasty between January 2000 and June 2019 (mean follow-up, 7.6 years). The survival rates of Swanson-type and Sutter-type implants were compared, using implant fracture as the end point after a radiographic evaluation. Clinical measures and upper limb functional assessments using the Disabilities of the Arm, Shoulder, and Hand (DASH) score were performed in the nested cohort. RESULTS: The 10.6-year survival rates for implant fracture of Swanson- and Sutter-type implants were 86.2% and 9.4%, respectively, with significantly higher survival noted for Swanson-type implants. The Sutter-type implant showed increased susceptibility to fracture in all four fingers compared to the Swanson-type implant. Implant fractures were primarily observed at the stem-hinge junction. There were no significant differences in upper limb function between the fractured and intact implant groups. CONCLUSIONS: Sutter-type implants were found to be more prone to fracture compared with Swanson-type implants. However, implant fractures did not significantly affect upper limb function. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IV.

What Plastic Surgeons Should Know about Small-Joint Arthroplasty: Is This for Your Practice?

SUMMARY: This article reviews the state of the art for arthroplasty of the metacarpophalangeal and proximal interphalangeal joints. Arthritis that affects these joints can result in significant pain and compromised function. The authors review indications for arthroplasty for each joint, types of implants to consider, technical considerations, patient expectations, and outcomes and complications.

Prosthetic arthroplasty of the proximal interphalangeal joint using a surface replacing implant (CapFlex-PIP): 3-year outcomes.

Level of evidence: IV.

Prosthesis Options for Proximal Interphalangeal Joint Arthroplasty in Osteoarthritis: A Systematic Review and Meta-Analysis.

Background: Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining indications and underlying pathologies in analyses. In this study, we aim to compare silicone, pyrocarbon and metal prostheses in PIP joint arthroplasty for primary degenerative osteoarthritis (OA). Methods: A review of scientific literature published between 1990 and 2021 was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant studies were screened and the appropriate data was extracted. An evaluation of clinical outcomes (range of motion [ROM] and pain), complications (reoperation) and survival rates for each prosthesis was performed. Results: Twelve studies were included for analysis with a total of 412 PIP joints. ROM was 66.6°, 55.8° and 46.4° for metal, silicone and pyrocarbon implants, respectively. Silicone implants had the best pain score on the visual analogue scale (1.2) followed by the pyrocarbon (2.6) and metal (3.9) groups. Complication rates were lowest in silicone implants (11.3%) compared to 18.5% in pyrocarbon and 22.4% in metal prostheses. Survival did not differ significantly amongst the three groups. Conclusions: Our findings suggest that for patients with primary degenerative OA, PIP joint arthroplasty using a silicone prosthesis can provide greater pain relief with lower complication rates compared to other implant options. Level of Evidence: Level III (Therapeutic).

Proximal Interphalangeal Joint Arthroplasty for Fracture.

Proximal interphalangeal joint arthroplasties can be performed in the setting of acute comminuted fracture, chronic fracture presentations, and posttraumatic arthritis. These surgeries provide excellent pain relief and patient satisfaction but patients should be cautioned not to expect an improvement in motion postoperatively. Despite high rates of minor complications and radiographic loosening, these implants have good rates of long-term survival with most revisions occurring in the early postoperative period. They provide viable alternatives to arthrodesis, osteotomy and amputation in the appropriate patient.

Does distal interphalangeal joint arthrodesis affect proximal interphalangeal joint arthroplasty outcomes in the same finger?

The purpose of this study was to analyse the 1-year outcomes after combining a surface replacing proximal interphalangeal joint arthroplasty and a distal interphalangeal screw arthrodesis and to compare the combined surgery with proximal interphalangeal joint arthroplasty alone. To obtain two groups with similar baseline data from our prospective registry, propensity score matching was used to match 23 fingers with the combined operations with 115 fingers with proximal interphalangeal joint arthroplasty alone. One year after surgery, the mean ranges of motion were 60° (95% CI: 53° to 67°) in the combined group and 63° (95% CI: 60° to 66°) in the control group and did not differ significantly. Grip strength, the brief Michigan Hand Questionnaire and pain also did not differ between the groups 1 year after surgery. All the proximal interphalangeal implants in patients treated with a distal interphalangeal screw arthrodesis remained in situ. Combining proximal interphalangeal joint arthroplasty with distal interphalangeal arthrodesis leads to 1-year outcomes that are similar to those achieved by proximal interphalangeal joint replacement alone.Level of evidence: III.

Managing Difficult Problems in Small Joint Arthroplasty: Challenges, Complications, and Revisions.

Small joint arthroplasty of the hand has been an established means of joint preservation and pain relief for over a half a century. Despite this, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint arthroplasty has not achieved the long-term success seen with hip and knee arthroplasty. Problems following MCP, PIP, and carpometacarpal (CMC) joint arthroplasty can include intraoperative fracture, postoperative dislocation, recurrent pain, limitation of motion, and instability. The hand surgeon needs to be prepared for these problems and their management. This article addresses the management of the most common complications seen following MCP, PIP, and CMC arthroplasty.

Radiological positioning of a proximal interphalangeal joint resurfacing implant: Reliability and functional outcomes correlation.

OBJECTIVES: The aims of this study were to define radiological measurements for quantifying the position of a surface replacing implant (CapFlex-PIP) in the proximal interphalangeal (PIP) joint, to test the reliability of these measurements, and to explore whether implant position influences patient-reported and clinical outcomes one year after surgery. MATERIAL AND METHODS: We developed 7 radiographic measurements to quantify the position of the proximal and distal implant components. Two independent surgeons analyzed the 1-year postoperative radiographs of 63 fingers documented in our registry. Inter-rater reliability of these measurements was calculated with the intraclass correlation coefficient (ICC). Correlations between the radiographic measurements and PIP range of motion (ROM), the brief Michigan Hand Outcomes Questionnaire (MHQ), and pain were determined using Spearman's correlation coefficient. Radiographic measurements of patients with the worst and best postoperative ROM were compared using the Mann-Whitney-U test. RESULTS: Inter-rater reliability was only good for 1 measurement (ICC = 0.89), but poor to moderate for the other measurements (ICC ranging from 0.34 to 0.69). These measurements neither correlated with ROM, brief MHQ nor pain based on correlation coefficients ranging from 0.00 to 0.31. There were no relevant differences in the radiographic measurements between patients with the worst and best ROM. CONCLUSION: The position of the CapFlex-PIP implant could not be reliably quantified on plain radiographs. The lack of correlations between implant position and postoperative outcomes can be attributed either to the unreliable measurements or the actual lack of influence of the implant position on pain and function.

Long-term survival of 2997 finger metacarpophalanageal joint arthroplasties from the Norwegian Arthroplasty Register.

We present the long-time survival of 2997 primary metacarpophalangeal (MCP) joint implants from the Norwegian Arthroplasty Register from 1994 to 2019. Six different implants were compared in terms of survival and risk of revision. The majority of implants were inserted in patients diagnosed with inflammatory diseases and in women. The overall survival was found to be 94%, 89%, 85% and 84% after 5, 10, 15 and 20 years. The most prevalent reason for revision was a fractured prosthetic component, and the second was pain. Implants inserted in the right hand and in younger patients had a higher risk for revision. Sex, type of implant, finger treated, one- or two-component prosthesis, and inflammatory or non-inflammatory conditions did not influence the survival. The frequency of MCP joint implantations decreased during the observation period. Our data show satisfactory long-term survival of the MCP implants, with no difference found between implant types or concepts.Level of evidence: II.

Arthroplasty of the Proximal Interphalangeal Joint With the TACTYS Prosthesis: Clinical and Radiographic Results With a Mean Follow-up of 5 Years.

BACKGROUND: Degenerative arthritis of the proximal interphalangeal (PIP) joint of the long fingers is a common disorder affecting mainly a female middle-aged population. Conservative treatment is often effective, but in some cases, pain can persist which can lead to invalidating function. Besides denervation and arthrodesis, arthroplasty is a valuable alternative treatment. The goal of this retrospective study was to determine the clinical and radiological outcomes of the TACTYS prosthesis with a mean follow-up of more than 5 years. METHODS: Between October 2005 and August 2019 10 joints in 9 patients, one patient had two prostheses in two separate fingers (4 males and 6 women) were treated for painful degenerative arthritis of the long fingers with a TACTYS prosthesis (Stryker Inc, Kalamazoo, Michigan). Power grip and pinch force were tested preoperatively and postoperatively, and the functional outcome survey is performed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), recall QuickDASH, and Patient-Rated Wrist Evaluation standardized questionnaires scored of 100 and the Visual Analog Scale (VAS) from 0 to 10. RESULTS: Mean follow-up was 65.70 months (range: 23-106). Mean age was 71.5 years (range: 64-83). QuickDASH score evolved from 68.43 to 41.92, range of motion from 37.5° to 45.1°, VAS from 6.65 to 1/10. Power grip and precision pinch evolved from 16.44 to 20.80 kg and 1.97 to 2.85 kg, respectively. CONCLUSIONS: TACTYS arthroplasty can be proposed for people who have been treated long enough with unsuccessful conservative treatment. Infection rate is still the highest complication, which can evolve in invalidating arthrodesis. It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain.

Arthroplasty for destroyed proximal interphalangeal joint in hand trauma surgery: Silicone hinged NeuFlex® or gliding Tactys®?

The treatment of proximal interphalangeal joints (PIP) after a traumatic injury has produced disappointing outcomes. The objective of this study was to evaluate the functional results of emergency hinged or gliding arthroplasty for destroyed PIP joints. A two-center retrospective study was carried out in 24 patients with open and closed trauma of the PIP joint of the fingers from 2007 to 2019. Fifteen hinged silicone implants (NeuFlex®) and nine gliding implants (Tactys®) were used. Pain on a visual analog scale (VAS), stability and total active motion (TAM), grip and pinch strength (Jamar®), QuickDASH and PRWE and satisfaction were assessed, and X-rays were performed. With a mean follow-up of 48 months, 24 patients aged 58 years on average were reviewed. Pain on VAS was 0.2/10, the TAM was 72% of the contralateral side, the QuickDASH was 15.6/100 and the PRWE was 24.5/100. PIP flexion was ≥50% of the contralateral side in 75% of patients. PIP and DIP extensor lag of 9° was significantly larger with the Tactys® than with the NeuFlex®, with no significant difference in the TAM. Three clinodactylies in fingers with the NeuFlex® and three reducible swanneck deformities in fingers with the Tactys® were noted. Three-quarters of patients were very satisfied or satisfied with the outcome. Emergency PIP arthroplasty with Tactys® seems to provide functional results that are as good as with NeuFlex®. Clinodactyly was found with NeuFlex® use. A significant PIP and IPD extensor lag of 9° and swan-neck deformities were found with Tactys® without significant functional impairment.

Outcome of the MatOrtho arthroplasty for PIP osteoarthritis with a minimum follow-up of two years.

The aim of this study is to report the early results of the MatOrtho arthroplasty, a newer generation resurfacing implant of the proximal interphalangeal joint. We performed a prospective cohort review of all MatOrtho arthroplasties implanted between 12/2013 and 05/2018 by a single surgeon at a single institution because of primary osteoarthritis, with a minimum follow-up of two years. Patient demographics, diagnosis, implant revision and other surgical interventions were recorded. Subjective and objective outcomes were evaluated, including range of motion, Patient Reported Outcome Measures and radiographic assessment. A total of 34 implants were inserted in 25 patients. Two implants were lost to follow-up. Pain scores improved significantly (mean VAS pre- op 7, mean VAS post-op 1, p < 0.05). Active range of motion improved in 83% (25/30) of joints, with a mean improvement of the total arc of motion of 25 degrees. On radiographic assessment, no signs of circumferential lucency or subsidence were observed. Additional surgery was necessary for three out of 32 implants, including implant removal in two cases. 93.75% (30/32) implants survived after a mean follow-up of 33 months. Our results confirm that at least at short term follow up, the MatOrtho PIP arthroplasty can be a successful procedure with high patient satisfaction and functional improvement.

Patient-Reported Outcomes 1 Year After Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis.

PURPOSE: Implant survival, range of motion, and complications of proximal interphalangeal joint arthroplasty have been reported often, but patient-reported outcomes are less frequently described. This study evaluated patients' experiences during the first year after proximal interphalangeal joint arthroplasty, measured with the Michigan Hand Outcomes Questionnaire (MHQ). The primary focus was the reduction of patient-reported pain after proximal interphalangeal joint implant placement and the percentage of patients who considered this reduction clinically relevant, indicated by the minimal clinically important difference (MCID). METHODS: Data were collected prospectively; 98 patients completed the MHQ before and at 3 and 12 months after surgery. Our primary outcome was the change in the pain score. An increase of 24 points or more was considered a clinically important difference. Secondary outcomes included changes in MHQ total and subscale scores and MCIDs, range of motion (ROM), patient satisfaction with the outcome of the surgery, and complications. RESULTS: The pain score improved significantly, from 42 (95% confidence interval, 38-46) at baseline to 65 (95% confidence interval, 60-69) at 12 months after surgery. The MCID was reached by 50% (n = 49) of patients. The ROM did not improve, reoperations occurred in 13% (n = 13) of patients, and swan neck deformities only occurred among surface replacement implants. CONCLUSIONS: Although most patients undergoing arthroplasty for osteoarthritis experienced significantly less pain after surgery, the pain reduction was considered clinically relevant in only 50% (n = 49) of patients. Patients with high MHQ pain scores before surgery are at risk for postoperative pain reduction that will not be clinically relevant. Likewise, the other subscales of the MHQ improved after surgery, but reached a clinically relevant improvement in only 46% (n = 45) to 63% (n = 62) of patients. This knowledge can be used during preoperative consultation to improve shared decision making. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

[Differential therapeutic Approaches in the prosthetic Arthroplasty of Finger Joints]. / Differentialtherapeutische Zugänge bei der prothetischen Versorgung von Fingergelenken.

Degenerative changes of the finger joints often lead to various surgical treatments such as arthrodesis or artificial joint replacement. There are a lot of surgical approaches for surgeons to choose from. The different approaches with their characteristic advantages and disadvantages during surgery and for the postoperative treatment should be selected and applied based on patient-, implant- and aftercare-specific indications. This article presents a short review of possible approaches and associated surgical techniques for finger joint replacement.

An Outcomes Study of Proximal Interphalangeal Joint Silicone Implant Arthroplasty Using the Volar Approach.

BACKGROUND: Arthroplasty is performed at the proximal interphalangeal joint for the management of disabling osteoarthritis. This prospective cohort study evaluated outcomes of the silicone implant for the proximal interphalangeal joint using the volar approach. The authors hypothesize that the volar approach without extensor mechanism disruption will provide improved motion and maintain joint extension. METHODS: Consecutive candidates for proximal interphalangeal joint silicone implant arthroplasty using the volar approach were evaluated. The Michigan Hand Outcomes Questionnaire and functional measurements, including grip/pinch strength and arc of motion, were administered preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. RESULTS: Twenty-eight patients (35 joints) were included in the study. Eighteen patients (24 joints) were followed to 1 year postoperatively, with an entire cohort average of 10-month follow-up. Nineteen patients were white women, and the mean age was 64 years. The authors' hypothesis was supported by the results showing a mean gain in arc of motion of 7 degrees and a mean 5-degree extension lag improvement at 1 year. The mean postoperative arc of motion was 53 degrees with a 10-degree average extension lag. The median Michigan Hand Outcomes Questionnaire pain score improved from 70 (60 to 80) to 28 (5 to 45); scores also improved for each of the questionnaire domains. Median grip strength was unchanged. CONCLUSIONS: The volar approach to proximal interphalangeal joint arthroplasty is technically challenging but facilitates early aggressive rehabilitation. This is critical for providing improved flexion, especially in the ulnar digits without worsening extension lag. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Outcomes of Multiple Digit Proximal Interphalangeal Joint Swanson Arthroplasty Done at a Single Operation.

Background: Proximal interphalangeal joint (PIPJ) arthroplasty using a Swanson implant is commonly used for the treatment of PIPJ arthritis despite newer implants being available. Many patients develop arthritis in more than one digit and some tend to have multiple digits operated on in their lifetime. There is paucity of literature on the outcomes of multiple PIPJ arthroplasty in one sitting. The aim of this study is to determine the outcomes of PIPJ arthroplasty using a Swanson implant done for multiple digits at one sitting. Methods: We retrospectively reviewed the outcomes of multiple Swanson PIPJ arthroplasty during a single operation from 2008 to 2018 in 13 patients (43 arthroplasties). We compared pre- and post-operative results of flexion/extension arcs, grip and pinch strength and questionnaires subsequently compared QuickDASH (Disabilities of Arm, Shoulder and Hand), Patient Evaluation Measure (PEM) and Visual Analogue Score (VAS) scores. Data were analysed with a Mann-Whitney U test. Results: Patients on average attended 5.6 hand therapy sessions over 5.1 months post-operatively. Average flexion/extension arc improved from 31.9° pre-operatively to 37.2° post-operatively. Average grip strength increased from 7.2 kg to 10.2 kg. The QuickDASH, PEM and VAS scores improved in keeping with the reported literature. There were no implant failures. Conclusion: We demonstrate similar outcomes for multi-digit Swanson PIPJ arthroplasty compared to the literature for single digit Swanson PIPJ arthroplasty. We conclude that multi-digit arthroplasty in a single operation is safe and effective. Level of Evidence: Level IV (Therapeutic).

Outcomes of Unconstrained Proximal Interphalangeal Joint Arthroplasty: A Systematic Review.

Background: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants and arthrodesis. This systematic review appraises their outcomes. Methods: Thirty studies comprising 1,324 joints (813 pyrocarbon, 511 MoP) were included. Mean patient age was 59 years (38-78) and mean follow-up period was 54 months (12-118). Results: There were mean improvements of 4.5 points (2-6.9) in pain visual analogue score, 10.5° (-26 to 58) in range of motion (ROM), 3.1 kg (-4 to 7) in grip strength, 0.6 kg (-1.5 to 2) in pinch strength and 18 points (-3 to 29) in the disabilities of the arm, shoulder and hand score, with no significant differences between implant types. ROM gains deteriorated over time. Clinical complications were frequent (23%) and significantly more common with pyrocarbon, as were radiographic complications. However, most were mild-moderate and did not necessarily correlate with negative outcomes or dissatisfaction. Overall re-operation rate was 21%, and revision rate 11%, both more frequent with pyrocarbon. Most revisions were within 24 months, beyond which survival was maintained up to 10 years. Conclusions: Unconstrained PIP joint arthroplasty is effective in improving pain scores, active ROM, grip/pinch strength and patient-reported outcome measures, particularly in patients with osteoarthritis. Results are generally maintained at least to the medium term, although gains diminish in the longer term. Complication and early revision rates are high, particularly with pyrocarbon implants. Most patients express positive attitudes to arthroplasty, with significant improvements in patient-reported outcome measures for both pyrocarbon and MoP implants. Patients with post-traumatic and inflammatory arthropathy are generally less satisfied. There is currently insufficient data to recommend one implant type over another, although the early-to-medium term results of MoP implants are promising. Prospective surveillance via small joint registries is recommended. Level of Evidence: Level III (Therapeutic).