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.

Outcome of proximal interphalangeal joint replacement with pyrocarbon implants: a long-term longitudinal follow-up study.

INTRODUCTION: The aim of this study was to compare the short-, mid-, and long-term results of pyrocarbon PIPJ arthroplasty. MATERIALS AND METHODS: Twenty-seven consecutive patients (9 males, 18 females) had arthroplasty for 32 pyrocarbon PIPJ prostheses. Two patients (two joints) were lost for follow-up. Four implants were removed during follow-up. Fifteen patients (18 implants) were available for a long-term follow-up assessment on average 9.7 (9-10.8) years postoperatively and seven patients with eight implants had telephone interviews to calculate the implant survival and complications. Of the 15 patients who came to the latest follow-up, 12 (14 implants) passed each of the three follow-up visits for short-term (ø 19 months), mid-term (ø 54 months), and long-term follow-up (ø 9.8 years) to compare functional and radiological parameters longitudinally. RESULTS: In total, seven of the 30 joints (23%) required a revision surgery, all within the first 2 years postoperatively, including three arthrodesis due to early infection or dislocation, and one distal component removal due to primary loosening. Three patients required soft tissue revisions. The implant survival after 9 years was 87%. There was minimal pain at rest throughout the 9-year follow-up analysis; pain with activity was rated 1.9 at the short-term assessment, 1.5 at mid-term, and 1.6 at long-term. The average active range of motion was at short-, mid-, and long-term examination 49°, 50°, and 48° and grip strength averaged 24, 24, and 21 kg, respectively. The DASH score was stable with 35, 36, and 33 points. At the long-term follow-up, all evaluated implants showed radiological signs of implant loosening or migration. According to the PIP joint outcome score, 57% resulted finally in a "good" outcome. CONCLUSIONS: Pyrocarbon PIPJ arthroplasty has a risk of early complications necessitating revision surgeries. In spite of radiological implant migration, good pain relief, grip strength, and high quality-of-life ratings are stable for a long time.

Arthroplasty of the proximal interphalangeal joint with the Tactys® modular prosthesis: Results in case of index finger and clinodactyly.

There are various surgical solutions for arthrosis of the proximal interphalangeal (PIP) joint: arthrodesis or denervation. Clinodactyly that is major and the index fingers are traditional contraindications for PIP arthroplasty prostheses. The recurrence of clinodactyly with ligament imbalance and mechanical complications are known complications. The purpose of our study was to evaluate the objective and subjective clinical results and radiological complications of Tactys® prostheses on the PIP joint of the index fingers or with clinodactyly of more than 5° in the other fingers. Two surgeons have implanted 35 total gliding modular Tactys® prostheses in 29 women and 3 men since 2010. The indications for surgery were arthrotic and painful PIP joints. Average pre-op clinodactyly was 7.03° (5-30°) with ulnar deviation (29 cases). Eleven index fingers presented with average clinodactyly of 14.2° (10-20°). The digits operated on were as follows: 13 index fingers, 14 middle fingers, 5 ring fingers and 3 little fingers. Arthrosis was primitive in 23 cases, post-traumatic in 6 cases and rheumatoid in 6 cases. The average age of patients undergoing surgery was 63.7 years (40-85). Objective (mobility, strength, index finger exclusion, scores, clinodactyly) and subjective (patient satisfaction, pain) functional results were collected by a neutral and independent observer, as were radiological complications. With an average follow-up of 2.6 years (1-6.3), the range of motion in all digits improved by 5.4° on average (55.5-60.8). The improvement in range of motion in the index fingers was 4.5° (57-61.5). Clinodactyly in all fingers was corrected by 1.36° (0-20). In the index fingers, average clinodactyly was 1.3° (0-10). The pinch strength in all PIP joints improved significantly from 2.3 kg (0.5-5) to 3.7 kg (1-8). On the PIP of the index fingers, the pinch strength had increased significantly from 2.5 kg (1-4) before surgery to 3.8 kg (1-7.5) post-op. Functional scores improved: PRWE (from 55.36 to 26.7/100), Quick DASH (from 54.6 to 30.5/100). Patient satisfaction was excellent in 15 cases, good in 8 cases, average in 10 cases, poor in 2 cases. The average VAS Pain Score improved from 5.6 to 1.45. We found 3 major complications requiring surgery: 2 stiffening and 1 mechanical loosening with secondary arthrodesis. Five patients presented with non-troublesome, reducible swan neck deformity and one algodystrophy. A gliding, fixed Tactys® prosthesis allowed us to restore ligament balance and to optimally rebalance the periarticular structures. The improvement in range of motion and the correction of clinodactyly was maintained over time. Total arthroplasty of the PIP with a Tactys® is no longer a formal contraindication for the index fingers and in cases of clinodactyly of more than 5°.

A novel dynamic distraction external fixator for proximal interphalangeal joint fracture dislocation.

OBJECTIVE: To evaluate the efficacy of a novel dynamic distraction external fixator for proximal interphalangeal joint (PIPJ) fracture-dislocation. METHODS: From March 2005 to March 2014, 20 patients with PIPJ fracture-dislocation were treated with our technique. Function scores according to the Michigan Hand Outcome Questionnaire (MHQ) score, union time, grip strength, and range of motion (ROM) were recorded before and after treatment. RESULTS: All patients completed a mean follow-up of 22 months (range, 12-60 months). All patients achieved fracture union and joint reduction. The mean union time was 3 months (range, 2-6 months). The mean postoperative MHQ score was 88.00 ± 3.42 (range, 84.00-92.00). Postoperative grip strength of the affected sides was 92% of the contralateral sides. X-rays showed that the fracture line disappeared completely with a good joint contour. The range of extension in the PIPJ was -5° (range, -10°-0°). The range of flexion in the PIPJ was 89.40° ± 9.79° (range, 75°-100°). Postoperatively, four patients had slight narrowing of the joint space and two had an uneven articular surface. Pin breakage, loosening, and tract infection were not observed. CONCLUSIONS: The novel dynamic distraction external fixator is a promising option for PIPJ fracture-dislocation.

Surface Replacement Proximal Interphalangeal Joint Arthroplasty: A Case Series.

Background: In 2012, our unit published our experience with a pyrocarbon proximal interphalangeal joint (PIPJ) implant. Due to high subsidence rates, a decision was made to change to a cemented surface replacement proximal interphalangeal joint (SR-PIPJ) implant. The purpose of this study was to assess whether the change to a cemented implant would improve the subsidence rates. Methods: Retrospective review of all patients who had a cemented SR-PIPJ arthroplasty performed from 2011 to 2013 with at least 12 months follow-up. Results: A total of 43 joints were included with an average follow-up of 26.5 months. There was a significant (P = .02) improvement in arc of motion with an average satisfaction score of 3.3 (satisfied patient). Subsidence was noted in 26% of joints with a significant difference in range of motion (P = .003) and patient satisfaction (P = .001) between the group with and without subsidence. Conclusions: The change to a cemented implant resulted in satisfied patients with an improvement in range of motion. The rate of subsidence improved but remains unacceptably high.

Proximal Interphalangeal Joint Silicone Arthroplasty for Osteoarthritis: Midterm Outcomes.

Background: Osteoarthritis of the proximal interphalangeal (PIP) joint affects a large percentage of the population and can lead to significant functional disability. The purpose of this study is to evaluate the midterm clinical effectiveness of PIP joint arthroplasty for nonrheumatic arthritis. Methods: A single-center retrospective cohort study evaluating preoperative and postoperative objective and subjective measures was conducted. Range of motion (ROM), Disabilities of the Arm, Shoulder and Hand scores, key pinch strength, grip strength, and satisfaction with respect to pain, deformity, function, and strength were measured. Results: Forty-five fingers in 25 patients were followed up for a mean period of 42 months. Preoperative and postoperative mean ROM was equivalent at 59.1° and 59.2°, respectively. Postoperative grip and key pinch strength showed significant improvement and near normalization compared with contralateral extremity. Complication rate was 37% with 20% requiring revision surgery. Patients with diabetes mellitus had higher odds of requiring revision surgery. Pain scores improved from 7.4 to 1.9 on a visual analog scale. Overall satisfaction was high at 84%, and 91% of patients would have the surgery performed again. Conclusions: Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. Our study presents midterm follow-up data that support significant pain relief, increased grip and key pinch strength, and high satisfaction associated with this implant.

Total Thumb Carpometacarpal Joint Arthroplasty: A Retrospective Functional Study of 28 MOOVIS Prostheses.

BACKGROUND: Trapeziometacarpal prostheses have been used for more than 50 years in the treatment of first carpometacarpal joint arthritis. Even though this technique is more expensive than trapeziectomy, it has many advantages such as faster convalescence with better patient comfort and improved strength and range of motion. The aim of this study was to report the early functional results of a patient cohort treated with a dual mobility thumb carpometacarpal joint prosthesis. METHODS: A retrospective study was performed to assess the functional results of 25 patients treated for trapeziometacarpal advanced osteoarthritis (Eaton and Littler stage III) with 28 MOOVIS prostheses. Preoperative and postoperative assessments included pain, range of motion, and pinch and grip strength. The average follow-up time was 27.5 months. RESULTS: The mean pain score measured by a visual analog scale was 8 preoperatively and 1 postoperatively. The mean preoperative Kapandji opposition score was 7 and counter-opposition score was 1; postoperative scores were 10 and 4, respectively. The grip strength improved after the surgery and the results were compared separately between dominant and nondominant sides. Final functional results were good: the mean Quick Disabilities of the Arm, Shoulder and Hand Questionnaire score was 12, and the mean Michigan Hand Outcomes score was 87%. CONCLUSIONS: Total joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution in our series. The absence of prosthesis instability encourages us to recommend this technique for the treatment of advanced trapeziometacarpal osteoarthritis for people having an activity without too many manual constraints.

Implant Arthroplasty: Selection of Exposure and Implant.

This review analyzes various surgical exposures and implant designs for proximal interphalangeal (PIP) joint pathology. Our literature review found that silicone implants using a volar approach had the best arc of motion, least extension lag, and lowest complication rates compared with all the other implant designs and approaches. Surface replacement arthroplasties had more frequent surgical revisions compared with silicone implants. Continued efforts toward the development of improved PIP joint implants are necessary.

Comparison of proximal interphalangeal arthroplasty outcomes with Swanson implant performed by volar versus dorsal approach.

No study has compared the QuickDASH score after Swanson implant arthroplasty performed by dorsal versus volar approaches. This study compared the outcomes of PIP arthroplasties through a volar approach as described by Schneider versus a dorsal approach as described by Chamay by determining the QuickDASH score, pain and range of motion. Our series included 21 Swanson implant arthroplasty cases in 17 patients aged 62 years on average, among which 12 were females. A volar approach was performed in 9 cases (group I) and a dorsal approach was performed in 12 cases (group II). The difference between the average QuickDASH score preoperatively and at the last follow-up was strong (group I: -16.584; group II: -1.444), the difference between the average pain level preoperatively and at the last follow up was very strong (group I: -2.098; group II: -4.506), the difference in average PIP extension was not different from 0 (group: I -5.805; group II: -11.332), the difference in average PIP flexion was very strong (group I: -2.716; group II: -2.007). There were four recurrences of swan neck deformity (3 in group, 1 in group II) and one implant fracture in each group. For Swanson implant arthroplasty, the volar approach leads to better QuickDASH scores and PIP flexion compared to the dorsal approach. The volar approach did not improve PIP extension, or pain, and did not lead to dysesthesia.

Comparative functional analysis between pyrolytic carbon prostheses and ligamentous suspension/reconstruction in the treatment of rhizarthrosis. / Análisis funcional comparativo entre la prótesis de carbón pirolítico y la artroplastia de suspensión-reconstrucción ligamentosa para el tratamiento de la rizartrosis del pulgar.

OBJECTIVE: To evaluate midterm functional outcome after pyrolytic carbon prosthesis (PyroDisk) implantation in the treatment of rhizarthrosis of the thumb, comparing outcomes with those of ligamentous resection/suspension/reconstruction. MATERIAL AND METHODS: A cross-sectional study retrospectively comparing 2patient groups aged between 40 and 65 years with rhizarthrosis of the thumb. Thirty-two patients operated between 2009 and 2013 were distributed between group i (interposition arthroplasy with PyroDisk implant) and group ii (ligamentous resection/suspension/reconstruction arthroplasty). Data on pain, functionality (Quick-Dash questionnaire) and articular movement were collected in 2015. In addition, a radiological study was undertaken using radiographs and CT. RESULTS: Thirty-two patients, 16 in each group with mean follow-up of 35 months (23-47). Pain at the end of follow-up was greater in the group with the pyrolytic carbon prosthesis (p=0.000). According to the QuickDash questionnaire, the patients in group i achieved a mean functionality of 31.14 (0-70) points compared to 15.81 (8-24) points for group ii (p=0.027). No differences were found in degree of mobility at the end of follow-up (p=0.46). The prosthesis had to be removed in 6 cases. DISCUSSION: The pyrolytic carbon prosthesis has been presented as an alternative treatment for rhizarthrosis of the thumb. The papers pubslished to date highlight the discrepancies in midterm functional outcomes. CONCLUSIONS: Pyrolitic carbon prostheses have shown inferior functional outcomes, compared with resection/suspension/reconstruction arthroplasties.

Metacarpophalangeal Joint Arthroplasty Using Flexible Hinge Toe Implant with Grommets for Boutonnière Deformity of Rheumatoid Thumb.

BACKGROUND: MP joint arthroplasty is one of the treatment options for the rheumatoid thumb with boutonniere deformity. The use of flexible hinge toe implant for MP joint reconstruction was introduced; however, the outcome of flexible toe implantation for the reconstruction of the MP joint has not as yet been reported in detail. Therefore, in this study, we retrospectively investigated the clinical outcome and radiological findings. METHODS: We assessed 56 Swanson implant arthroplasties that used flexible hinge toe implants with grommets to address boutonnière deformity of the thumb MP joint. The minimum follow-up period was 6 months. Pain, the range of motion, grip strength, pinch strength, General health Visual analogue scale and DASH (Disabilities of Hand, Shoulder and Hand) were assessed. RESULTS: For most of the patients, the procedure provided painless motion and stability to the thumb. In the radiological assessments, the preoperative flexion angles at the MP joint were 45° improved to 17°. The origin of arc was shifted toward the extended position and the average arc of motion was 21°, with a flexion arc from 23° to 44°. The severity of boutonniere deformity was improved in most cases. The average grip strength changed from 110 to 121 mmHg and the average side pinch power changed from 1.5 to 2.2 kgf. General health VAS improved from 40 to 29 (p = 0.019), and the DAS28-CRP decreased from 3.3 to 2.4 (p < 0.001). Infection occurred in one case, and there were no implant fractures. CONCLUSIONS: Swanson flexible hinge toe implant arthroplasty with grommets applied to the MP joint of the thumb was one of the recommended procedures for the reconstruction of boutonnière deformity of the thumb.

Outcomes of Surface Replacement Proximal Interphalangeal Joint Arthroplasty Using the Self Locking Finger Joint Implant: Minimum Two Years Follow-up.

BACKGROUND: The Self Locking Finger Joint (SLFJ) implant is a new type of surface replacement implant. The purpose of this study was to evaluate midterm clinical outcomes of the proximal interphalangeal (PIP) arthroplasty with the SLFJ implant. METHODS: We retrospectively studied 26 PIP joint arthroplasties using the SLFJ implant in 17 patients with osteoarthritis or posttraumatic osteoarthritis. Preoperative and postoperative range of motion, grip strength and key pinch, radiographic findings, and complications were evaluated. The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS) score, course of pain, and patient satisfaction were obtained. RESULTS: The mean follow-up time was 44 months (range, 24-76 months). The average active PIP joint arc of motion improved from 36° before surgery to 44° after surgery. Grip strength and key pinch showed no statistical difference between preoperative and postoperative assessments. The average DASH score and VAS score improved from 40 to 15 and from 5 to 1, respectively. Overall patient satisfaction was 94%. Ninety percent of implants showed osteointegration, and there were no radiographic signs of migration and loosening. Three joints (12%) showed abnormal heterotopic bone formation. Four joints (15%) had secondary surgery-1 joint needing joint head and socket replacement and 3 joints needing contracture release. CONCLUSIONS: Our minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion. The SLFJ implant showed good osteointegration. Further longer-term prospective studies with various types of currently available implants are needed.

Cold Welding in a Trapeziometacarpal Ball and Socket Prosthesis: A Case Report.

While in revision hip surgery it has been described cold welding of the femoral component in titanium implants, no previous reports have been published in TMC prosthesis. We present a case report of a patient who sustained a TMC ARPE® dislocation 11 months after surgery and during revision surgery, cold welding of the neck with the metacarpal stem was observed. This may represent a problem when revising this prosthesis and alternative procedures should be advised and discussed with the patient when revising these implants.

Metallosis After Swanson Spacer as Indication for Volar Synovectomy 12 Years After Implantation.

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.

Arthroplasty of the proximal interphalangeal joint with the TACTYS® prosthesis: Preliminary results after a minimum follow-up of 2 years.

The TACTYS® implant is a new anatomic gliding articular and modular prosthesis for the proximal interphalangeal (PIP) joint. We report preliminary results with a minimum follow-up of 2 years. Twenty-two patients with a mean age of 63 years were operated on at a single center by two senior hand surgeons. Indications were painful and stiff PIP joints. The joint damage was caused by osteoarthritis (18 cases), post-traumatic arthritis (3) and rheumatoid arthritis (1). All prostheses were implanted through a dorsal mid-line transtendinous approach. Postoperative active and passive range of motion in flexion and extension was performed immediately with a protective splint for 2weeks. All patients were evaluated (pain, range of motion, strength, function, X-rays) with a mean follow-up of 34months (range 24-50). Pain decreased from 6.5 preoperatively to 1.9 postoperatively on a VAS scale. Flexion-extension range of motion increased from 39° preoperatively to 58° postoperatively. Grip strength was 21kg preoperatively and 25kg postoperatively. Pinch strength was 3kg preoperatively and 5kg postoperatively. Functional QuickDASH and PRWE scores were significantly improved at the last follow-up. Four patients were reoperated on: dorsal tenoarthrolysis in 3 cases and volar osteophyte removal in 1 case. All implants were still in place at the last follow-up. On X-rays, there were no signs of implant migration or loosening. The modularity of the prosthesis seems to be this implant's greatest advantage. The TACTYS® prosthesis is a reliable alternative to other conventional PIP implants.

Metacarpophalangeal Joint Arthroplasty in the Setting of Trauma.

PURPOSE: To report the outcome of pyrocarbon metacarpophalangeal (MCP) joint implants with traumatic nonreconstructible articular cartilage loss. METHODS: We performed a review of all patients at a single institution who underwent a pyrocarbon MCP joint arthroplasty performed after an acute injury. Of 820 MCP joint arthroplasties performed, 10 were performed in 7 patients for open MCP joint trauma within 24 hours of the initial injury. Six were hemi- and 4 were total arthroplasties. The mean follow-up was 4 years. All injuries were the result of a direct laceration over the MCP joint. RESULTS: There were no cases of revision or postoperative infection. Mean total arc of motions for the MCP, proximal interphalangeal, and distal interphalangeal joints were 56° (30° to 70°), 76° (40° to 100°), and 50° (21° to 70°), respectively. Postoperative mean grip, oppositional pinch, and appositional pinch strengths were 28, 9, and 11 kg, respectively. All patients except one reported no or mild pain at the last follow-up. Half of the patients required a tenolysis. CONCLUSIONS: MCP joint arthroplasty was performed safely in the setting of acute complex open MCP joint trauma. Patients had preservation of adequate MCP joint motion and experienced little pain. MCP arthroplasty should be a consideration in cases of open MCP joint trauma to preserve motion, prevent pain, and avoid fusion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Advances in small joint arthroplasty of the hand.

Substantial effort has been directed at the development of small joint prostheses for the hand. Despite advances in prosthetic joint design, outcomes have been relatively unchanged over the past 60 years. Pain relief and range of motion achieved after surgery have yet to mirror the success of large joint arthroplasty. Innovations in biotechnology and stem cell applications for damaged joint surfaces may someday make prostheses obsolete. The purpose of this review is to describe the current status, ongoing advances, and future of small joint arthroplasty of the hand.

Proximal interphalangeal joint arthroplasty with Neuflex® implants: relevance of the volar approach and early rehabilitation.

Proximal interphalangeal joint arthroplasty through a volar approach preserves the extensor apparatus, which allows for early active rehabilitation. Here, we report on the results of 28 silicone implants in patients suffering from rheumatoid arthritis (12 joints) or osteoarthritis (16 joints) with a mean follow-up of 39 months. Pain was reduced significantly after arthroplasty. Range of motion increased significantly by 29° with a mean postoperative value of 58°; the mean extension deficit was reduced from 14° to 5°. There were 18 cases of preoperative ulnar drift with a mean value of 13°, compared with 13 cases postoperatively with a mean value of 7°. Three cases (10%) of implant fracture were noted on the radiology reports. The mean DASH score at follow-up was 35/100. Immediate active mobilization led to significant shortening in recovery time. The improvement in mobility and extension seems to be higher than that obtained with other approaches. Clinodactyly remains problematic no matter the type of arthroplasty.

[Do artificial joints perform in the hand?]. / Funktionieren Kunstgelenke an der Hand?

For selected indications and implantation by an experienced hand surgeon, we can answer "in principle: yes". Through artificial joints in the hand, especially of the finger joints, a significant reduction in pain can usually be achieved. Compromises must be made with respect to mobility. Age, general condition, underlying disease, requirements and expectations must be considered in the indication. In appropriate patient selection, we have positive experience with high patient satisfaction after implantation of artificial joints in the hand.