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.

Management of the capsule in trapeziometacarpal joint implant arthroplasty: resection versus repair.

We compared the effects of capsule resection versus capsule suturing in patients treated with a dual-mobility trapeziometacarpal joint prosthesis. We included 131 patients with capsular resection and 57 patients with repair. The mean scores for pain and the brief Michigan Hand Outcomes Questionnaire were similar between the groups preoperatively and at 6 weeks and 1 year postoperatively. Mean key pinch strength was also similar in both groups before surgery and at 1 year, but higher in the capsular resection than in the suture group at 6 weeks. The incidence of complications reported throughout the 1-year postoperative period was not significantly different between the groups. One implant in the capsular resection group was revised for reasons most likely unrelated to capsule management. We conclude that the capsule can be safely resected during trapeziometacarpal joint implant arthroplasty.Level of evidence: III.

Are patients satisfied with online video consultations for assessing their hand disorder?

OBJECTIVES: The aim was to evaluate patient satisfaction with online video consultations in assessing hand disorder. MATERIAL AND METHODS: This prospective study included patients who attended a video consultation, either as an initial meeting to assess the need for further evaluation or treatment or as an early postoperative follow-up consultation. After the consultation, they completed a satisfaction questionnaire. Regression models were used to reveal determinants of patient satisfaction. RESULTS: We included 100 patients, with a mean age of 55 years (range 17-81 years). 95% were satisfied or very satisfied. The main reasons for choosing this form of consultation were shorter travel and wait times. Age, gender and educational level did not determine satisfaction. Significant factors for dissatisfaction were insufficient video and sound quality. CONCLUSION: Online video consultation in hand surgery is a valuable alternative to in-clinic appointments for all age groups. However, it is crucial to ensure adequate video and audio quality.

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.

Short-term recovery after implant versus resection arthroplasty in trapeziometacarpal joint osteoarthritis.

We compared the short-term recovery of patients treated with trapeziometacarpal joint (TMJ) implant arthroplasty versus resection-suspension-interposition (RSI) arthroplasty. Implant patients (n = 147) had a better 3-month postoperative brief Michigan Hand Outcomes Questionnaire (MHQ) score (mean 82) compared to RSI patients (n = 127), who had a mean score of 69. Key pinch strength at 3 months was also higher in the implant group compared to the RSI group (6.8 kg vs. 3.1 kg). At 1 year, both groups had similar brief MHQ scores, but key pinch remained higher in the implant group (7.0 kg vs. 3.9 kg [RSI]). After implant arthroplasty, employed patients returned to work after a mean of 44 days, which was significantly faster than the 84 days for RSI patients. Patients after TMJ implant arthroplasty recover significantly faster in the first 3 postoperative months compared to RSI patients. However, 1-year postoperative outcomes are similar for both cohorts, with key pinch strength remaining higher for patients with TMJ implant arthroplasty.Level of evidence: II.

Low complication rate and high implant survival at 2 years after Touch® trapeziometacarpal joint arthroplasty.

We analysed complications, revision surgeries, and patient-reported and clinical outcomes 2 years after trapeziometacarpal joint implant arthroplasty using the Touch® prosthesis. Of 130 operated patients with trapeziometacarpal joint osteoarthritis, four had to be revised owing to implant dislocation, loosening or impingement, leading to an estimated 2-year survival rate of 96% (95% confidence interval: 90 to 99). Of 101 patients available for the 2-year follow-up, complications occurred in 17, with the most frequent being de Quervain stenosing vaginosis (n = 6) and trigger thumb (n = 5). Pain at rest decreased significantly from a median value of 5 (interquartile range [IQR]: 4 to 7) before surgery to 0 (IQR: 0 to 1) at 2 years. Key pinch strength increased significantly from 4.5 kg (IQR: 3.0 to 6.5) to 7.0 kg (IQR: 6.0 to 8.0). We recommend surgery with the Touch® prosthesis as the standard procedure for patients with isolated trapeziometacarpal joint osteoarthritis because of the high survival rate and promising outcomes at 2 years.Level of evidence: IV.

Preoperative Thresholds of Pain and Function to Achieve a Minimal Important Change and Patient Acceptable Symptom State After Proximal Interphalangeal Joint Arthroplasty.

PURPOSE: There is ongoing discussion about the level of symptoms patients with proximal interphalangeal (PIP) joint osteoarthritis should have to undergo surgery. The aims of our study were to determine the minimal important change (MIC) and patient acceptable symptom state (PASS) for PIP joint range of motion (ROM), and define clinically relevant thresholds of preoperative pain and function at which patients have the greatest chance to achieve a MIC and PASS in these outcomes 1 year after PIP arthroplasty. METHODS: We analyzed registry data that included patients with PIP joint osteoarthritis who underwent an arthroplasty for this condition and had a 1-year follow-up. Patients indicated pain on a numeric rating scale (0-10) and completed the brief Michigan Hand Outcomes Questionnaire (MHQ). Active total PIP ROM was measured. The preoperative thresholds, predictive of achieving the MIC and PASS for each outcome measure of pain, function, and ROM, were determined using receiver operating characteristics curves. RESULTS: We included 196 patients who experienced a relevant improvement in ROM (= MIC) when there was an increase by ≥8° compared with the ROM preoperatively. Patients were satisfied with their postoperative ROM (= PASS) if they achieved PIP mobility of at least 66°. Pain at rest and during activities was predictive for achieving a MIC but not a PASS. Due to an insufficient area under the curve for the brief MHQ and ROM, their baseline values cannot predict the postoperative achievement of MIC or PASS. We suggest that patients with preoperative pain at rest ≥4.5 or pain during activities ≥5.5 have the greatest chance of achieving a subjectively relevant change 1 year after surgery. CONCLUSIONS: The determined thresholds may support surgeons in the preoperative process of deciding for or against a surgical intervention and explain the probability of achieving sufficient postoperative symptom relief for the patient. LEVEL OF EVIDENCE: Prognostic I.

Three-Dimensionally Planned and Printed Patient-Tailored Plates for Corrective Osteotomies of the Distal Radius and Forearm.

PURPOSE: We evaluated the 1-year postoperative clinical and patient-reported outcomes in patients who had a 3-dimensional planned corrective osteotomy of their distal radius, radial shaft, or ulnar shaft using a printed, anatomical, patient-tailored plate to determine the feasibility and effectiveness of this methodology. METHODS: Simulations in computer-assisted preoperative planning of corrective osteotomies resulted in 3-dimensionally printed surgical guides, surgical models, and anatomically customized plates for application at the distal radius and forearm. Patients with malunions of the distal radius or forearm who underwent fixation with the custom-made plates were documented in our registry. Grip strength and range of motion assessments were made before surgery (baseline), as well as at 6 weeks and 3 and 12 months. Additionally, patients rated their wrist-related pain and disability using the Patient-Rated Wrist Evaluation. RESULTS: Fifteen patients underwent corrective surgery, and the 1-year follow-up data of 14 patients with a median age of 56 years (interquartile range, 24-64 years) were available for analysis. The median baseline Patient-Rated Wrist Evaluation score improved from 47 to 7 after 1 year. The flexion-extension arc of motion of the wrist increased from 90° at baseline to 130° at 1 year and the pronation-supination arc of motion of the wrist increased from 135° to 160° in the same time period. Differences in radiological measurements for palmar and radial inclinations, as well as for ulnar variance between the affected and contralateral wrists, were reduced with the osteotomy. In 1 case, the plate was removed 11 months after the osteotomy. No severe adverse events were reported. CONCLUSIONS: Three-dimensionally planned and printed patient-tailored plates offer a reliable method for correcting even complex malunions of the distal radius and forearm. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic 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.

Outcomes and recommendations for revision of thumb carpometacarpal resection arthroplasty.

This study investigated revision surgery for the thumb after failed trapeziectomy with ligament reconstruction and tendon interposition and defined a revision concept. Twenty-four patients with 25 affected thumbs were examined at a mean of 5.5 years after their last revision operation. Pain during daily activities was 2.7 on a 0-10 numeric rating scale, pain at rest was 1.6 and the brief Michigan Hand Outcomes Questionnaire score was 63. Although 68% of patients indicated that their thumb was better than before primary surgery, the outcome after revision surgery was less favourable than that reported for primary trapeziectomy with ligament reconstruction and tendon interposition. We defined a revision algorithm to use as a guide for patients with residual symptoms after resection arthroplasty. The main reason for revision, symptomatic impingement of the thumb metacarpal, should be treated with resection of the metacarpal base and scaphotrapezoidal joint. An existing interposition should be revised, or a new interposition should be used, preferably with an autologous tendon or alternately with an allograft.Level of evidence: IV.

Surface replacing arthroplasty of the proximal interphalangeal joint using the CapFlex-PIP implant: a prospective study with 5-year outcomes.

The purpose of this prospective study was to evaluate the 5-year outcomes in patients after proximal interphalangeal joint arthroplasty using the surface replacing implant, CapFlex-PIP. Ninety-two prosthesis were implanted and 65 patients with 68 implants were available for follow-up. The brief Michigan Hand Outcomes Questionnaire score improved significantly from 45 (SD 15) before surgery to 71 (SD 17) at 5 years. On the numeric rating scale, pain during activities decreased significantly from 6.4 (SD 1.9) to 1.8 (SD 1.9). Range of motion of the joints increased significantly from 45° (SD 21) to 54° (SD 24). An axis deviation of more than 5° was found in 65% of the joints before surgery, but only in 25% at 5 years. Soft tissue reoperations were performed on eight patients. Four out of 92 implants underwent revision for stiffness or implant loosening. In three implants, the distal component migrated without needing revision. Overall, the CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint.Level of evidence: IV.

Complications after surface replacing and silicone PIP arthroplasty: an analysis of 703 implants.

INTRODUCTION: The aim was to analyse complications after surface replacing and silicone proximal interphalangeal (PIP) joint arthroplasty. MATERIALS AND METHODS: All complications, reoperations (subsequent intervention without implant modification) and revisions (subsequent surgery with implant modification or removal) were extracted out of our registry for two cohorts: (1) Patients who received a surface replacing arthroplasty at the PIP joint using the CapFlex-PIP prosthesis and (2) patients who received a PIP silicone implant. Furthermore, radiographs were evaluated for deviations from the longitudinal finger axis. RESULTS: In our registry, 279 surface replacing implants and 424 silicone implants have been documented. The overall complication rate was 20% for surface replacements and 11% for silicone arthroplasties (p ≤ 0.01) with soft tissue-related events being the most prevalent in both groups. Reoperations were significantly more frequent after surface replacement (5.4%) than silicone arthroplasty (0.5%; p ≤ 0.001), while the revision rates did not differ significantly (4.4% and 3.3%, respectively; p = 0.542). Postoperative axis deviations were significantly less frequent in the surface replacement group (19% versus 58% for silicone arthroplasty; p ≤ 0.001). CONCLUSION: We recommend using a surface replacing implant in fingers with preoperative axis deviations and correctable anatomical situation, bearing in mind the higher risk of a second surgery. However, treatment outcomes also need to be considered before choosing one implant over another.

Silicone arthroplasty versus screw arthrodesis in distal interphalangeal joint osteoarthritis.

The aim of this study was to evaluate patient satisfaction after distal interphalangeal joint silicone arthroplasty and compare this outcome to that achieved with screw arthrodesis. On average 4.4 years after surgery, range of motion of the distal interphalangeal joint, pain on a numeric rating scale, satisfaction, and hand appearance of 48 patients (78 treated fingers) were assessed. For arthroplasty patients, mean distal interphalangeal joint motion was 28° with an extension deficit of 17°. Pain was low for arthroplasty and arthrodesis patients with scores of 0.2 and 0.6 out of a total of 10 points, respectively. The patients in both groups were satisfied with their outcomes, but arthroplasty patients were less satisfied with the appearance. Twenty-one per cent of the arthroplasties and 15% of the arthrodeses underwent reoperation. We suggest the motion-preserving distal interphalangeal arthroplasty as an alternative to distal interphalangeal arthrodesis for patients with higher functional demands and whose joints are stable preoperatively. In patients attaching importance to hand aesthetics and for unstable joints, distal interphalangeal joint arthrodesis is preferable. Level of evidence: III.

Comparison of outcomes of three surgical approaches for proximal interphalangeal joint arthroplasty using a surface-replacing implant.

The objective was to compare outcomes of the volar, Chamay and tendon splitting approaches for proximal interphalangeal joint arthroplasty using a surface-replacing implant (CapFlex-PIP). One-hundred prospectively documented patients with a 2-year follow-up were included. Range of proximal interphalangeal joint motion, the brief Michigan Hand Outcomes Questionnaire and complications were analysed. Between baseline and follow-up, mean proximal interphalangeal joint motion increased for the volar (53° to 54°), Chamay (38° to 53°) and tendon splitting (40° to 61°) approaches. The volar approach yielded the greatest flexion and the highest extension deficit. The mean brief Michigan Hand Outcomes Questionnaire scores at baseline and 2 years were 45 and 74 (volar), 45 and 66 (Chamay) and 41 and 75 (tendon splitting). Seven patients in the Chamay group and two in the volar group required a reoperation consisting of teno-/arthrolysis. The tendon splitting approach tended to result in the best outcomes that were associated with fewer complications compared with the volar and Chamay approaches. Level of evidence: IV.

[Arthroplasty at the proximal interphalengeal joint]. / Gelenkersatz am Fingermittelgelenk.

BACKGROUND: For the treatment of deformed finger middle joints that occur as a result of osteoarthritis or inflammatory and post-traumatic destruction, artificial joint replacement is an option to arthrodesis. Hereby mobility can be obtained, which is why this method generally has a higher acceptance. DISCUSSION: What clinical and subjective results can be expected after artificial finger middle joint replacement and what is the expected complication rate for the different types of joints? MATERIAL AND METHODS: We present our experiences with artificial joint replacement with various implants over the past decades as well as promising new developments of the last 10 years. RESULTS: The silicone implant still remains the gold standard in joint replacement. For these implants, good long-term results and low revision rates have been documented. Due to the soft flexible material, however, lateral stability and preoperatively-existing axis deviations seem problematic. Initial studies with modular resurfacing implants appear promising and may eventually replace the silicone spacer over the long term. Consequently, long-term results of these modern implants are pending. CONCLUSIONS: Painful osteoarthritis of the finger joint can be treated well with motion-preserving artificial joints. The complication rate appears to be decreasing. New generation modular surface prostheses seem to be relatively equal to the silicone spacer in terms of long-term outcomes.

Minimal important change and patient acceptable symptom state for patients after proximal interphalangeal joint arthroplasty.

Our aim was to determine the minimal important change and patient acceptable symptom state for pain and the brief Michigan Hand Outcomes Questionnaire in patients 1 year after proximal interphalangeaI joint arthroplasty. We analysed data of 100 patients from our prospective registry. The minimal important change and patient acceptable symptom state were determined with anchor-based methods, and patients with better or worse baseline status were examined. The minimal important change for pain at rest and during activities, and the brief Michigan Hand Outcomes Questionnaire was -1.2, -2.8 and 18, respectively, with corresponding patient acceptable symptom state values of 1.5, 2.5 and 64. Patients with higher baseline symptoms rated more severe postoperative symptoms as acceptable, whereas patients with lower baseline symptoms were only satisfied with a low level of pain and high level of hand function. The minimal important change and patient acceptable symptom state are useful estimates for patient outcomes and study results. Level of evidence: IV.

Complications, reoperations and revisions after proximal interphalangeal joint arthroplasty: a systematic review and meta-analysis.

This systematic review and meta-analysis investigates the prevalence of complications, reoperations (surgeries without implant modifications) and revisions (surgeries with implant modifications) after proximal interphalangeal joint arthroplasty with pyrocarbon, metal-polyethylene and silicone implants. Thirty-four articles investigating 1868 proximal interphalangeal joints were included. Implant-related complications were associated with 14%, 10% and 11% of the pyrocarbon, metal-polyethylene and silicone implants, respectively, yet these rates were not significantly different from one another. Silicone implants showed more finger deviations (3%) and instabilities (2%) compared with the other implants. Reoperations were fewer for silicone arthroplasties (1%) compared with pyrocarbon (7%) and metal-polyethylene implants (10%). The revision rates of 4%, 3% and 2% were similar for pyrocarbon, metal-polyethylene and silicone implants. Our results indicate that silicone implants remain a valuable option for the treatment of stable proximal interphalangeal joints. Surface replacing implants might be better to correct unstable or deviated proximal interphalangeal joints, although they are associated with a higher risk of reoperations.

Trapeziectomy With Suspension-Interposition Arthroplasty for Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial Comparing the Use of Allograft Versus Flexor Carpi Radialis Tendon.

PURPOSE: The objective of this randomized controlled trial was to compare the 12-month postoperative Michigan Hand Outcomes Questionnaire (MHQ) total score between patients with osteoarthritis (OA) at the first carpometacarpal (CMC I) joint who underwent trapeziectomy with suspension-interposition arthroplasty using the flexor carpi radialis (FCR) tendon and those receiving a human dermal collagen template (allograft). METHODS: We included 60 patients with CMC I OA who met the indications for surgery. They were randomized into 1 of 2 groups: trapeziectomy using the FCR tendon or trapeziectomy with the allograft for suspension-interposition. Patients completed a set of questionnaires including the MHQ and were clinically assessed at baseline, 6 weeks, and 3, 6, and 12 months after surgery. Complications were recorded. RESULTS: We operated on 29 patients using the FCR tendon; 31 patients received an allograft. Baseline MHQ total scores significantly increased from 51 (95% confidence interval [CI], 46-56) to 83 (95% CI, 78-87) and 53 (95% CI, 47-58) to 76 (95% CI, 69-84) by 12 months in the FCR and allograft groups, respectively. We found similar outcomes for both groups at all follow-up assessments. Five complications occurred in the FCR group, and 10 in the allograft group. Revision surgery was required for one allograft patient. CONCLUSIONS: The use of the FCR tendon or allograft for trapeziectomy with suspension-interposition arthroplasty in patients with CMC I OA leads to similar outcomes with more complications, mainly tendon irritations, associated with the latter. Therefore, we only use the allograft in cases of severe instability requiring a larger amount of suspension-interposition material or for revision procedures after failed suspension-interposition with the FCR tendon. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.