Surface replacement arthroplasty of the proximal interphalangeal joint

Proximal interphalangeal joint arthroplasty with the Tactys® prosthesis: Clinical and radiological outcomes at a mean 3.1 years' follow-up

Preliminary results with the Tactys® modular gliding prosthesis for proximal interphalangeal joint (PIPJ) replacement were encouraging, with notable improvement in clinical and functional scores at 1 and 2 years' follow-up. However, a recent study found a trend for deterioration over time. We wanted to check this by analyzing medium-term outcomes. Sixty-four arthroplasties were performed in 48 patients in single facility between January 2015 and January 2020. Clinical, functional, and radiographic outcomes were analyzed at short- and medium-term follow-up for 15 of these arthroplasties. Mean follow-up of the 48 patients was 3.1 years. Pain significantly decreased on the numeric rating scale (p < 0.01) and the functional QuickDASH score improved from 67.3 to 55.9 (p < 0.01). Grip and pinch strengths were lower in the operated than in the contralateral hand (p = 0.04 and p = 0.6, respectively). PIPJ active range of motion (ROM) in flexion/extension improved from 44° to 49.4° (p = 0.17). 70% of the 48 patients were satisfied. Fifteen arthroplasties were analyzed at 17 and 61 months' follow-up. Pain relief continued. ROM decreased from 57° to 46° (p < 0.05) and the functional QuickDASH score deteriorated from 25.8 to 54.7 (p < 0.01). Both grip and pinch strength increased, with a significant difference in pinch (p = 0.003). The main complication was swan-neck deformity (46%), with a mean 11 months' onset. Our results confirmed the deterioration trend observed over time in the functional results of the Tactys® prosthesis despite, good patient satisfaction. LEVEL OF EVIDENCE: 4.

Radiographic and surgical considerations in arthritis surgery of the hand

Indications for hand surgeries include unremitting joint pain, deformity and stiffness, often secondary to arthritis. Several surgical options are available, including arthrodesis (fusion) and joint arthroplasty. Classically arthrodesis is performed in situations with poor bone stock and supporting soft tissues. Arthroplasty is reserved for patients and joints in which preservation of function is important and bone stock and soft tissue support are adequate. In this article we will review various techniques for arthrodesis and arthroplasty, their post-surgical imaging appearance, including key findings important to surgeons, and the findings that indicate post-surgical complications. Radiographs are the mainstay for postoperative evaluation and will be the focus of the imaging portions of this review. Advanced imaging modalities will be reviewed when applicable.

Change in the collateral and accessory collateral ligament lengths of the proximal interphalangeal joint using cadaveric model three-dimensional laser scanning

The purpose of this study was to assess the lengths of the index and middle finger proximal interphalangeal joint ligaments and determine the relative changes in the collateral and accessory collateral ligament lengths at 0°, 45° and 90° flexion. We generated three-dimensional scans of 16 finger (eight index and eight middle) proximal interphalangeal joints to assess relative changes in ligament length. Significant changes were found between 45°-90° and 0°-90° for the ulnar collateral ligament of the index finger and both collateral ligaments of the middle finger between 45°-90° and 0°-90°. No significant changes in length were found for the radial collateral ligament of the index finger or the accessory collateral ligaments of the index and middle fingers. Overall, it was found that the collateral ligament length changed significantly, but there was no significant change in the accessory collateral ligaments.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

A modular surface gliding implant (CapFlex-PIP) for proximal interphalangeal joint osteoarthritis: a prospective case series

PURPOSE

To evaluate the one-year postoperative clinical and patient-rated outcomes in patients receiving proximal interphalangeal (PIP) joint arthroplasty with a modular surface gliding implant, CapFlex-PIP.

METHODS

10 patients each with primary osteoarthritis of a single PIP joint were assessed preoperatively (baseline), at 6 weeks, and 3, 6, and 12 months after CapFlex-PIP arthroplasty for lateral stability and range of motion of the affected digit. In addition, patients rated their pain using a numeric rating scale and function and overall assessment of their treatment and condition using the quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Evaluation Measure (PEM) questionnaires, respectively.

RESULTS

The mean baseline active mobility of the affected PIP joint increased from 42° to 51° by one year, although this change was not significant. Patients reported reduced pain at one year, which was statistically significant. There was also a significant improvement between baseline and one-year QuickDASH (43 points vs 15 points, respectively) and PEM scores (51 vs 25 points, respectively). Absent or low lateral instability was observed in 9 joints at follow-up. All implants remained intact over the one-year postoperative period and there was no migration, osteolysis, or implant fracture. After study completion, 2 patients underwent tenolysis.

CONCLUSIONS

Patients experienced a significant reduction in pain and a trend towards increased mobility. All implants showed complete osteointegration without evidence of radiological migration. Lateral stability improved.

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.

Silicone proximal interphalangeal joint arthroplasty for primary osteoarthritis using a volar approach

PURPOSE

To evaluate the short-term clinical and radiographic outcome of a silicone proximal interphalangeal (PIP) joint implant using a volar approach in patients with primary osteoarthritis.

METHODS

We retrospectively reviewed 36 proximal PIP joints that were replaced with Avanta silicone implants in 26 patients. Inclusion criteria were diagnosis of primary osteoarthrtitis of the PIP joint and failure to respond to conservative treatment. Clinical asessment included range of motion, patient satisfaction, and pain scores. The Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire was administered at final follow-up. Radiographs were reviewed for alignment and implant fracture. Complications were also recorded.

RESULTS

After an average follow-up of 18 months (range, 12-60 mo), pain relief was markedly reduced in all patients, decreasing from a mean score of 7.2 preoperatively to 0.4 postoperatively. The arc of active motion of the PIP joint improved from 33° to 72°. Satisfaction averaged 4.8 on a 5-point Likert scale, and all patients stated they would repeat the surgery. The median final average Quick-Disabilities of the Arm, Shoulder, and Hand score was 7 (range, 4-12). Radiograph review showed 2 implant fractures at 1 and 2 years after surgery, respectively, but without clinical changes. The average deformity in the coronal plane changed from 12° (range, 8° to 18°) preoperatively to 4° (range, 3° to 8°) postoperatively, whereas the average flexion contracture changed from 18° (range, 10° to 30°) to 0° (all patients achieved full active extension). No other complications were observed. No revision surgery has been needed to date.

CONCLUSIONS

The volar approach to PIP joint silicone arthroplasty offers the advantages of maintaining the integrity of the extensor mechanism, providing pain relief, and improving postoperative range of motion with minimal complications. However, further research is needed to determine the long-term efficacy of this implant.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Medium-term outcomes of pyrocarbon arthroplasty of the proximal interphalangeal joint

We evaluated the outcome of pyrocarbon arthroplasty for proximal interphalangeal joint osteoarthritis in 18 arthroplasties carried out by a single surgeon using the Ascension prosthesis (Ascension Orthopedics Inc., Austin, Texas) in 15 patients after a mean of 6.2 years. Significant and maintained improvements in pain scores at rest and on active movements were achieved for surviving implants, and the range of motion was comparable with preoperative measurements. The radiographs, which were evaluated for evidence of ongoing migration and potential failure, were of concern in 10 out of 18 joints. Two patients required implant removal.

Long-term outcomes of proximal interphalangeal joint surface replacement arthroplasty

BACKGROUND

Surface replacement arthroplasty is a reconstructive alternative for the treatment of pain and deformity due to osteoarthritis and rheumatoid arthritis of the proximal interphalangeal joint of the finger. This retrospective study was performed to examine long-term outcomes of proximal interphalangeal joint prosthetic surface replacement with a proximal cobalt-chromium (CoCr) and distal ultra-high molecular-weight polyethylene component over thirty years at a single institution.

METHODS

Sixty-seven prostheses were implanted in forty-seven patients between 1974 and 2007. The mean duration of follow-up was 8.8 years. There were fifty joints (75%) with osteoarthritis and seventeen (25%) with rheumatoid arthritis. Fifty-six prostheses (84%) were implanted via a dorsal approach, forty-eight (72%) were cemented, and nineteen (28%) were press-fit. Postoperative evaluation, consisting of a clinical history and examination, radiographs, the Short Form-36 (SF-36) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, and a visual analog scale (VAS) pain score, was performed for thirty-six patients. Demographic, surgical, and implant failure data were obtained from the medical charts of eleven patients (sixteen implants) who had died prior to the time of postoperative follow-up.

RESULTS

At the time of follow-up, the median total active proximal interphalangeal joint motion was 40°. Eight prostheses had failed, yielding a cumulative incidence of implant failure of 3% at one year, 8% at three years, 11% at five years, and 16% at fifteen through twenty-five years. Prostheses implanted via a volar approach failed more often than those implanted via a dorsal approach (relative risk: 6.59, p = 0.004). The failure rate did not differ significantly between patients with rheumatoid arthritis and those with osteoarthritis (p = 0.17). The median VAS pain score at the time of follow-up was 3 (of a maximum of 100). There were twenty-two complications in fourteen patients, resulting in four interphalangeal fusions and two amputations. There were no infections.

CONCLUSIONS

Proximal interphalangeal surface replacement arthroplasty is a reliable treatment alternative for pain and deformity due to proximal interphalangeal joint osteoarthritis and rheumatoid arthritis. At the time of long-term follow-up, pain was minimal and joint motion was similar to preoperative levels.

Surface replacement arthroplasty of the proximal interphalangeal and metacarpophalangeal joints: The current state

Surface replacement arthroplasty for proximal interphalangeal joint and metacarpophalangeal joints are becoming popular. Low profile, anatomically designed implants limit the amount of bone removed but need preservation of the collateral ligaments. Pyrocarbon and cobalt-chrome stemmed unconstrained implants on ultra-high molecular weight polyethylene are the two commonly available bearing surfaces. The indications for small joint arthroplasty are degenerative, post-traumatic or rheumatoid arthritis. Early results are encouraging, primarily in patient satisfaction and pain relief, but are based on low numbers. The main concerns are progressive loss of range due to implant settling, dislocation, squeaking and poor osteo-integration with the appearance of a radiolucent line at the bone-implant interface. Our experience suggests that metacarpophalangeal joint replacements consistently give good results.

Reoperations following proximal interphalangeal joint nonconstrained arthroplasties

PURPOSE

To retrospectively analyze the reasons for reoperations following primary nonconstrained proximal interphalangeal (PIP) joint arthroplasty and review clinical outcomes in this group of patients with 1 or more reoperations.

METHODS

Between 2001 and 2009, 294 nonconstrained (203 pyrocarbon and 91 metal-plastic) PIP joint replacements were performed in our institution. A total of 76 fingers (59 patients) required reoperation (50 pyrocarbon and 26 metal-plastic). There were 40 women and 19 men with an average age of 51 years (range, 19-83 y). Primary diagnoses included osteoarthritis in 35, posttraumatic arthritis in 24, and inflammatory arthritis in 17 patients. There were 21 index, 27 middle, 18 ring, and 10 small fingers. The average number of reoperations per PIP joint was 1.6 (range, 1-4). A total of 45 joints had 1 reoperation, 19 had 2, 11 had 3, and 1 had 4.

RESULTS

Extensor mechanism dysfunction was the most common reason for reoperation; it involved 51 of 76 fingers and was associated with Chamay or tendon-reflecting surgical approaches. Additional etiologies included component loosening in 17, collateral ligament failure in 10, and volar plate contracture in 8 cases. Inflammatory arthritis was associated with collateral ligament failure. Six fingers were eventually amputated, 9 had PIP joint arthrodeses, and 2 had resection arthroplasties. The arthrodesis and amputation rates correlated with the increased number of reoperations per finger. Clinically, most patients had no or mild pain at the most recent follow-up, and the PIP joint range-of-motion was not significantly different from preoperative values. Pain levels improved with longer follow-up.

CONCLUSIONS

Reoperations following primary nonconstrained PIP joint arthroplasties are common. Extensor mechanism dysfunction was the most common reason for reoperation. The average reoperation rate was 1.6, and arthrodesis and amputation are associated with an increasing number of operations. Overall clinical outcomes demonstrated no significant change in range of motion, and most patients had mild or no pain.

Surface replacement arthroplasty of the proximal interphalangeal joint using the PIP-SRA implant: results, complications, and revisions

PURPOSE

To evaluate the subjective and objective results of surface replacement arthroplasty (SRA) for arthritis of the proximal interphalangeal (PIP) joint using the PIP-SRA implant. Emphasis is placed on causes of complications, failures, and techniques used for revision.

METHODS

This is a retrospective review of 43 surface replacement PIP joint arthroplasties performed in 25 patients using the PIP-SRA implant. Subjective results were obtained through a mailed questionnaire. Pre- and postoperative ranges of motion were obtained for PIP joints and DIP joints. X-rays were evaluated for signs of subsidence, periprosthetic radiolucency, loosening, or stress-shielding. Joints requiring revision were separately analyzed.

RESULTS

The average follow-up time was 37 months (range, 12 to 72 months). The average active PIP joint arc of motion went from 57 degrees before surgery to 58 degrees after surgery, excluding 2 joints that were salvaged with arthrodesis. The average active DIP joint arc of motion went from 36 degrees before surgery to 24 degrees after surgery, excluding arthrodeses. Satisfaction rating revealed 26 very satisfactory (60%), 12 fairly satisfactory (28%), and 5 not satisfactory (12%). Thirty-three patients rated their joint pain better, 3 joints were unchanged, and 7 were worse. Eleven (26%) arthroplasties failed, requiring major revision (arthrodesis or replacement of 1 or both components) for pain. Ten of 11 revisions were due to loosening associated with the lack of cement. Revision procedures produced satisfactory results in 8 of 11 joints.

CONCLUSIONS

Surface replacement arthroplasty of the PIP joint holds promise for the future. It offers motion and stability for the index finger unattainable with silicone arthroplasty. Our results do not differ notably from those of other series using this implant, except that failures due to loosening in our study were almost exclusively associated with the lack of cement. Therefore, we recommend using cement with the PIP-SRA implant in every case until superior long-term results can be demonstrated using uncemented components. Proximal interphalangeal joint arthroplasty is an exacting procedure no matter what technique or implant is used, and no one technique has yet been proven superior to all others.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Cemented versus uncemented surface replacement arthroplasty of the proximal interphalangeal joint with a mean 5-year follow-up

PURPOSE

To retrospectively compare the long-term results of cemented and uncemented surface replacement arthroplasties of the proximal interphalangeal (PIP) joint in a single surgeon's experience.

METHODS

A cemented prosthesis was used on 18 patients for 27 PIP joints between February 1997 and September 2000. An uncemented prosthesis was used on 18 patients for 21 PIP joints between September 2000 and June 2003. The preoperative and postoperative pain score (0-10) during activities of daily living and the active range of motion for each digit as well as radiographs were assessed. Patients with less than 2 year of follow-up were excluded unless the short follow-up was due to prosthesis removal. Mean follow-up was 5 years.

RESULTS

Data were available for 28 patients who collectively received 24 cemented implants and 19 uncemented implants. The average length of follow-up was 4 years for the uncemented group and 6 years for the cemented group. The average pain score decreased by 5.5 units after the operation, and the average arc of motion increased by 13 degrees after the operation. No evidence was found for any association between implant type and postoperative pain and motion measurements. Very strong evidence was found for an association between implant type and subsidence, with 1 cemented implant subsiding compared with 13 uncemented implants. There was no evidence for an association between implant type and joint failure.

CONCLUSIONS

There was no difference in the postoperative pain scores or the postoperative arc of motion for the cemented versus the uncemented group. There were significantly more cases with radiologic evidence of loosening in the uncemented group (p < .001). Revision rate was higher in the uncemented group (26%) compared with that of the cemented group (8%), but this was not a significant difference (risk difference, -0.18; 95% confidence interval, -0.040 to 0.05).