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Caudle K, Mickley JP, Moses A, James N, Weller WIJ, Calandruccio JH. Management of Index Finger Metacarpophalangeal Joint Arthritis. Orthop Clin North Am 2024; 55:479-488. [PMID: 39216953 DOI: 10.1016/j.ocl.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Metacarpophalangeal joint arthritis of the index finger is a debilitating disease often caused by osteoarthritis or inflammatory arthritides such as rheumatoid arthritis. Treatment options include nonsurgical management with nonsteroidal anti-inflammatory drugs, splinting, occupational therapy, corticosteroid injections, and disease-modifying antirheumatic drugs. Operative management options include arthrodesis and arthroplasty, which can be further broken down into silicone implants and 2 component resurfacing implants. The article summarizes the current literature for each of the treatment options for metacarpophalangeal joint arthritis of the index finger.
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Affiliation(s)
- Krysta Caudle
- Department of Orthopaedics, University of Florida Health Jacksonville, 655 West 8th Street, ACC 2nd floor, Jacksonville, FL 32209, USA
| | - John P Mickley
- Department of Orthopaedics, University of Florida Health Jacksonville, 655 West 8th Street, ACC 2nd floor, Jacksonville, FL 32209, USA
| | - Alex Moses
- Department of Orthopaedics, University of Florida Health Jacksonville, 655 West 8th Street, ACC 2nd floor, Jacksonville, FL 32209, USA
| | - Nicholas James
- Department of Orthopaedics, University of Florida Health Jacksonville, 655 West 8th Street, ACC 2nd floor, Jacksonville, FL 32209, USA.
| | - WIlliam J Weller
- Campbell Clinic Department of Orthopaedics, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
| | - James H Calandruccio
- Campbell Clinic Department of Orthopaedics, University of Tennessee Health Science Center, 7887 Wolf River Boulevard, Germantown, TN 38138, USA
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Filardi V, Vaishya R. Comparative Finite Element (FE) Analysis of the Mechanical Behavior in an Innovative Nitinol Staple for Arthrodesis in Distal Interphalangeal Joint. J Hand Microsurg 2024; 16:100040. [PMID: 38855509 PMCID: PMC11144644 DOI: 10.1055/s-0043-1769091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Objective Osteoarthritis (OA) is a source of significant limitations for individuals, health systems, and economies. The most common complications of OA are often associated with risk factors related to chronic diseases, cardiovascular disease, and depression. In this article, a new kind of staple is proposed, designed to provide better strength when subjected to bending and torque loads. Methods This innovative staple has been numerically tested and compared to a MEMOFIX staple by Smith + Nephew, in order to evaluate its mechanical behavior. The radius and ulna were fixed at the lower extremity, while the distal interphalangeal of the little finger was loaded with a bending load of 50 N and a torque moment of 500 N/mm2. Results For the bending load, a maximum value of stress of 120 MPa in the traditional staple, while 90 MPa are registered in the innovative one. The torsional load produces a value of 107 MPa in the traditional staple and 85 MPa in the innovative one. Conclusion Computational simulations showed the biomechanical performance of a new type of nitinol staple compared with a traditional one. This staple is designed with an elliptical shape in order to support different kinds of loads. Our results confirm an optimal mechanical behavior, compared to the traditional staple, in terms of the evaluated Equivalent Von Mises stress; also the contact force exerted by the innovative staple was increased.
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Affiliation(s)
- V. Filardi
- Administrative Department of Research and Internationalization, University of Messina, Messina, Italy
| | - R. Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
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Huang H, Wu C, Huang Y, Yin C, Huang S, Wang J. Dual Parallel Intramedullary K-Wires for Arthrodesis of the Finger Distal or Thumb Interphalangeal Joints. Orthop Surg 2023; 15:2966-2973. [PMID: 37680173 PMCID: PMC10622260 DOI: 10.1111/os.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE K-wire arthrodesis methods are commonly used during arthrodesis of the finger distal interphalangeal (DIP) or thumb interphalangeal (IP) joints. Here we propose an advantageous approach involving dual parallel intramedullary K-wires with the K-wire tips cut to bury underneath the skin. METHODS From January 2017 to December 2021, 35 patients (43 joints) underwent finger DIP or thumb IP joint arthrodesis using this method. Radiographic outcomes were evaluated, while functional outcomes were assessed using the visual analogue scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Patients with at least 1 year follow-up were analyzed. The preoperative and postoperative functional results were analyzed using the paired t-test. RESULTS Arthrodesis union was achieved in 41/43 joints (95.3%). We treated 10 thumb IP joints and 33 finger DIP joints, for which the underlying cause was osteoarthritis and trauma in 37 and six digits, respectively. The average time of K-wire removal was 8.9 (range, 7-10) weeks after surgery. Twenty-four patients (27 joints; 22 women, two men) had at least 1 year follow-up (mean 15.9; range, 12.5-40.8) months. For patients with bone healing, the VAS score improved from 6.6 (range, 5-8) to 0.6 (range, 0-1) (p < 0.001), and the QuickDASH score improved from 57.9 (range, 31.8-77.3) to 14.7 (range, 6.8-20.5) (p < 0.001) at final follow-up. Both of the two failure cases were in the thumb. There were no other complications. CONCLUSIONS This technique is simple and cost-effective and achieves a good union rate. The advantages include the ability to choose variable K-wire sizes according to the size of the medullary canal and the ease of postoperative care.
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Affiliation(s)
- Hui‐Kuang Huang
- Department of OrthopaedicsDitmanson Medical Foundation Chiayi Christian HospitalChiayiTaiwan
- Department of Orthopaedics and TraumatologyTaipei Veterans General HospitalTaipeiTaiwan
- Department of Surgery, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Food NutritionChung Hwa University of Medical TechnologyTainanTaiwan
| | - Chin‐Hsien Wu
- Department of Orthopaedics, E‐Da Hospital, College of MedicineI‐Shou UniversityKaohsiungTaiwan
| | - Yi‐Chao Huang
- Department of Orthopaedics and TraumatologyTaipei Veterans General HospitalTaipeiTaiwan
- Department of Surgery, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Cheng‐Yu Yin
- Department of Orthopaedics and TraumatologyTaipei Veterans General HospitalTaipeiTaiwan
- Department of Surgery, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Shu‐Ling Huang
- Department of Food NutritionChung Hwa University of Medical TechnologyTainanTaiwan
| | - Jung‐Pan Wang
- Department of Orthopaedics and TraumatologyTaipei Veterans General HospitalTaipeiTaiwan
- Department of Surgery, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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Liang KW, Wang B, Huang HH, Tsao TF, Tyan YS, Wang PH. Effectiveness and Safety of Intra-arterial Imipenem/Cilastatin Sodium Infusion for Patients with Hand Osteoarthritis-Related Interphalangeal Joint Pain. J Vasc Interv Radiol 2023; 34:1485-1492.e1. [PMID: 37295555 DOI: 10.1016/j.jvir.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of intra-arterial imipenem/cilastatin sodium (IPM/CS) infusion for painful interphalangeal joint osteoarthritis (OA). MATERIALS AND METHODS Fifty-eight patients with interphalangeal joint OA who underwent intra-arterial IPM/CS infusion were retrospectively evaluated. Intra-arterial infusions were performed via percutaneous wrist arterial access. The Numerical Rating Scale (NRS), Functional Index for Hand Osteoarthritis (FIHOA), and Patient Global Impression of Change (PGIC) scale scores were assessed at intervals of 1, 3, 6, 12, and 18 months. Clinical success was evaluated based on PGIC. RESULTS All patients were followed up for at least 6 months after treatment. Of them, 30 and 6 patients were followed up for 12 and 18 months, respectively. No severe or life-threatening adverse events were encountered. The mean NRS score was 6.0 ± 1.4 at baseline, which significantly decreased to 2.8 ± 1.4, 2.2 ± 1.9, and 2.4 ± 1.9 at 1, 3, and 6 months after treatment, respectively (all P < .001). The mean NRS scores were 2.8 ± 1.7 and 2.9 ± 1.9 at 12 and 18 months, respectively, in the remaining patients. The mean FIHOA score significantly decreased from 9.8 ± 5.0 at the baseline to 4.1 ± 3.5 at 3 months (P < .001). The mean FIHOA score was 4.5 ± 3.3 at 12 months in the remaining 30 patients. The clinical success rates based on PGIC at 1, 3, 6, 12, and 18 months were 62.1%, 77.6%, 70.7%, 63.4%, and 50.0%, respectively. CONCLUSIONS Intra-arterial IPM/CS infusion is a potential treatment option for interphalangeal joint OA refractory to medical management.
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Affiliation(s)
- Keng-Wei Liang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Teng-Fu Tsao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Xu J, Gilpin B, McCarron L, Sivakumar B, Graham D. Distal Interphalangeal Joint Arthroplasty - A Systematic Review. J Hand Surg Asian Pac Vol 2023; 28:409-414. [PMID: 37501548 DOI: 10.1142/s2424835523500443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background: Arthritis of the distal interphalangeal joint (DIPJ) can result in significant functional limitations and pain. While arthrodesis is the most common surgical intervention, this can decrease grip strength and have other limitations. DIPJ arthroplasty may be an appealing alternative in select patient with this study aiming to review the outcomes of this procedure. Methods: A search was conducted according to PRISMA guidelines using PubMed, Embase and Ovid Medline from date of inception to April 2022. Relevant studies were included if they reported on complications and functional outcomes of DIPJ arthroplasty. Data was then extracted and analysed. Results: Seven studies were included including 171 patients with 269 digits. The mean age was 62.1 years, with 81% of the cohort being female. The indication for surgery was osteoarthritis in 97% of patients. Surgical approaches varied from dorsal transverse, dorsal T-incision, dorsal H-incision to radial incisions. A silicone implant was used in all patients. A total of 97.7% of patients were satisfied with their outcome, and pain improved or eliminated in all patients where it was reported. Joint stability was noted in 97.4% of cases. The mean preoperative DIPJ range of motion was 24° and improved to 36° post-operation. The mean preoperative extensor lag was 24° and reduced to 13° post operation. The rate of re-operation was 7.1%. Conclusions: DIPJ arthroplasty may be a viable alternative to arthrodesis in certain settings, providing high patient satisfaction, improvements in digital range of motion and relief of pain. However, the available literature is sparse, and limited by low-quality studies and heterogenous outcome reporting. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Joshua Xu
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Bradley Gilpin
- Department of Musculoskeletal Services Gold Coast University Hospital, Southport, QLD, Australia
- Griffith University School of Medicine and Dentistry, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital South Brisbane, QLD, Australia
| | - Luke McCarron
- Department of Musculoskeletal Services Gold Coast University Hospital, Southport, QLD, Australia
| | - Brahman Sivakumar
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- Discipline of Surgery, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Australian Research Collaboration on Hands (ARCH) Mudgeeraba, QLD, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
- Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - David Graham
- Griffith University School of Medicine and Dentistry, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital South Brisbane, QLD, Australia
- Australian Research Collaboration on Hands (ARCH) Mudgeeraba, QLD, Australia
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Matter-Parrat V. Proximal interphalangeal joint prosthetic arthroplasty. HAND SURGERY & REHABILITATION 2023; 42:184-193. [PMID: 36803657 DOI: 10.1016/j.hansur.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
Surgical treatment of the painful proximal interphalangeal (PIP) joint has evolved considerably over the past century. If arthrodesis has long been the gold standard and remains so for some, prosthesis would meet patient demand: mobility and indolence. Faced with a demanding patient, the surgeon must decide the indication, the type of prosthesis, the approach, the post-operative follow-up, etc. The history of the development of PIP prostheses demonstrates the complexity of the treatment of the destroyed PIP: appearance of prostheses, evolution and sometimes disappearance from the market for commercial reasons or related to complications. The main objective of this conference is to identify the main indications for prosthetic arthroplasties and to describe the various prostheses available on the market.
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Affiliation(s)
- V Matter-Parrat
- Institut Monégasque de Médecine et Chirurgie Sportive (IM2S), 11, Avenue d'Ostende, Monaco 98000, Monaco.
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Runkel A, Bonaventura B, Sundermann B, Zajonc H, Eisenhardt S, Leibig N. Risk factors in distal interphalangeal joint arthrodesis in the hand: a retrospective study of 173 cases. J Hand Surg Eur Vol 2022; 47:907-914. [PMID: 35850591 DOI: 10.1177/17531934221111641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this retrospective study we aimed to analyse the risk factors for complications after different methods of distal interphalangeal arthrodesis in the hand. Forty-four per cent were treated with K-wire/cerclage fixation, 46% with X-fuse® implants (Stryker GmbH, Selzach, Switzerland) and 10% with headless compression screws (HBS®-screw, KLS Martin Group, Tuttlingen, Germany). The median follow-up was 16 weeks (range 6-224). The overall complication incidence was 44% (minor complications 29% and major 15%). The logistic regression showed that osteoarthritis, revisional arthrodesis and smoking had a negative impact on the total complication incidence. A Cox-regression analysis showed that HBS®-screw arthrodesis was associated with a significantly lower incidence of major complications compared with K-wire/cerclage and X-Fuse®-arthrodesis. Revisional arthrodesis was five times more frequently connected with major complications than primary surgery. Smokers were three times more likely to experience major complications than non-smokers. We conclude that arthrodesis of the distal interphalangeal joint often leads to complications. Risk factors must be kept in mind.Level of evidence: III.
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Affiliation(s)
- Alexander Runkel
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Bastian Bonaventura
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Britta Sundermann
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Horst Zajonc
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Steffen Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Nico Leibig
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Vonderlind HC, Eisenschenk A, Strüwer J, Millrose M. [Arthrodesis of the distal interphalangeal Joint - a literature Review]. HANDCHIR MIKROCHIR P 2021; 54:5-20. [PMID: 34544198 DOI: 10.1055/a-1560-2677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This review addresses the arthrodesis of the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb with focus on indications, approaches, preparation of the articular surfaces, the angle of arthrodesis, advances and disadvantages of each technique, and postoperative care.
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Affiliation(s)
| | - Andreas Eisenschenk
- Unfallkrankenhaus Berlin Abteilung für Hand-, Replantations- und Mikrochirurgie
| | - Johannes Strüwer
- Klinikum Oldenburg AoR Universitätsklinik für Orthopädie und Unfallchirurgie
| | - Michael Millrose
- Klinikum Garmisch-Partenkirchen, Abteilung für Unfallchirurgie, Sportorthopädie & Kindertraumatologie
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Neukom L, Marks M, Hensler S, Kündig S, Herren DB, Schindele S. Silicone arthroplasty versus screw arthrodesis in distal interphalangeal joint osteoarthritis. J Hand Surg Eur Vol 2020; 45:615-621. [PMID: 32338192 DOI: 10.1177/1753193420917818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Lisa Neukom
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Stefanie Hensler
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Sylvia Kündig
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Gandolfi S, Carloni R, Mouton J, Auquit-Auckbur I. Finger joint denervation in hand osteoarthritis: Indications, surgical techniques and outcomes. A systematic review of published cases. HAND SURGERY & REHABILITATION 2020; 39:239-250. [PMID: 32171925 DOI: 10.1016/j.hansur.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/02/2020] [Accepted: 02/08/2020] [Indexed: 10/24/2022]
Abstract
In cases of osteoarthritis with preserved motion, joint denervation can be an effective alternative to arthroplasty or arthrodesis to reduce joint-related pain. Although denervation is a standardized procedure for wrist osteoarthritis, it is used sparingly for finger joints. We conducted a systematic review to summarize reported cases of finger joint denervation in hand osteoarthritis with a specific focus on surgical procedures and postoperative outcomes. PubMed, Cochrane and Science Direct databases were searched from 1998 to 2019 and 13 relevant articles were selected. Three hundred and twenty-five denervations were conducted on 291 patients. Distal interphalangeal (DIP) joint denervation was performed through a dorsal approach; 83% of patients were satisfied with the surgery and complications occurred in 58%. Proximal interphalangeal (PIP) joint denervation was performed through a palmar approach; 90% of patients were satisfied with the surgery; complications were observed in 14%. Good results were observed in 95% of patients who underwent metacarpophalangeal (MCP) joint denervation; complications were observed in 26%; denervation was carried out with dorsal and palmar approaches in all cases. Denervation of the trapeziometacarpal (TMC) joint was achieved through the Wagner approach (61%), multiple incisions (26%), or dorsal approach (13%); satisfaction rate was 91%, with a 6% complication rate. Finger joint denervation in hand osteoarthritis is a simple and effective procedure, providing satisfactory pain relief. Good results are reported in all studies, especially for PIP and TMC joint denervation. Further investigations should be conducted on DIP and MCP joint denervation.
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Affiliation(s)
- S Gandolfi
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France.
| | - R Carloni
- Department of Plastic, Reconstructive Surgery, Hopital Privé de l'Estuaire, 505, rue Irène Joliot-Curie, 76620 Le Havre, France
| | - J Mouton
- Department of Orthopedic Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France
| | - I Auquit-Auckbur
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France
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Politikou O, Giesen T, Reissner L, Calcagni M. Hand and wrist joint procedures in patients with scleroderma: a systematic review. J Hand Surg Eur Vol 2019; 44:402-407. [PMID: 30176750 DOI: 10.1177/1753193418795632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We aimed to examine if joint procedures in hands and wrists of patients with scleroderma could be performed without major morbidity and conducted a systematic review of the literature to assess this hypothesis. Studies were identified in four different databases; soft tissue procedures in scleroderma patients were excluded, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven studies out of an initial total of 203 articles were included. One-hundred and twelve scleroderma patients with a total of 402 joint procedures in the hand and wrist were identified. A low complication incidence, comparable with that of non-sclerodermic population, in terms of infection, wound healing problems, and nonunion was reported in all studies. The application of joint procedures in scleroderma hands and wrists seems to be associated with low morbidity.
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Affiliation(s)
- Olga Politikou
- Division of Plastic Surgery and Hand Surgery, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Thomas Giesen
- Division of Plastic Surgery and Hand Surgery, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Lisa Reissner
- Division of Plastic Surgery and Hand Surgery, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, UniversitätsSpital Zürich, Zürich, Switzerland
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12
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Understanding Patient Preferences in Proximal Interphalangeal Joint Surgery for Osteoarthritis: A Conjoint Analysis. J Hand Surg Am 2018; 43:615-624.e4. [PMID: 29627279 DOI: 10.1016/j.jhsa.2018.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/16/2018] [Accepted: 03/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to compare preferences for arthroplasty versus arthrodesis among patients with proximal interphalangeal (PIP) joint osteoarthritis (OA) by quantifying the patient-assigned utility of each operation's attributes. METHODS We undertook a multistep process to identify relevant surgical attributes, including a literature review, surgeon survey, and pretest patient pilot test to build a set of discrete choice experiments. Patients with PIP joint osteoarthritis were identified using a single university electronic medical record and were recruited via electronic message or postcard. Participants completed a demographic survey and 11 discrete choice experiments designed using Sawtooth Software's Discover tool. Utility and importance scores were generated for each attribute. RESULTS Pretest analysis identified out-of-pocket cost, joint stiffness, need for future surgery, change in grip strength, and total recovery time as the most important surgical attributes. Initial response rate to the conjoint survey was 75% and survey completion rate was 61%. The study sample was predominantly white (91%) and female (72%), mean age 64.3 years (range, 34-90 years), and mean daily pain score was 4.32 (range, 0-10). Attribute importance scores demonstrated that joint stiffness (32%) and grip strength (29%) were most important to patients. Cost (17%) and need for future surgery (19%) were intermediate patient-preference drivers. Recovery time was the least important attribute (2%). CONCLUSIONS In aggregate, patients prefer surgical attributes characteristic of arthroplasty (ability to preserve joint motion and grip strength) relative to those associated with arthrodesis (decreased need for reoperation, lower costs, and shorter reoperation times). TYPE OF STUDY/LEVEL OF EVIDENCE Economic/Decision Analysis III.
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