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

Metallosis Associated with Pyrocarbon Proximal Interphalangeal Joint Implant - A Case Report

Arthroplasty of the small joints of the hand and fingers is a complex problem facing the hand surgeon. Pyrocarbon implants have been available for several decades. They were originally thought to provide better functional outcomes than silicone implants in patients, mostly due to recreation of the joint anatomy. In a recent publication, pyrocarbon proximal interphalangeal joint (PIPJ) arthroplasty was found to have a higher complication and revision rate. We present a patient with pyrocarbon metallosis of the PIPJ in a revision arthroplasty procedure. Level of Evidence: Level V (Therapeutic).

Small Joint Denervation of the Hand and Thumb Base: History, Anatomy, Technique, and Outcomes

Painful arthritis of the small joints of the hand is a common condition affecting older adults, with distal interphalangeal joint and thumb carpometacarpal joint being the two most common locations. Younger adults may also develop painful arthritis after trauma and with inflammatory arthropathy. Traditional surgical approaches address the structure of the joints with either arthrodesis or arthroplasty with or without an implant. In recent decades, denervation has been reported as an alternative treatment for painful small joints that are mobile and stable. Publications on denervation often report faster surgery and recovery times than traditional surgeries that manipulate the small joint bony structures. This article reviews the history, anatomy, surgical techniques, and outcomes of denervation of the small joints of the hand.

Development of novel hybrid 3D-printed degradable artificial joints incorporating electrospun pharmaceutical- and growth factor-loaded nanofibers for small joint reconstruction

Small joint reconstruction remains challenging and can lead to prosthesis-related complications, mainly due to the suboptimal performance of the silicone materials used and adverse host reactions. In this study, we developed hybrid artificial joints using three-dimensional printing (3D printing) for polycaprolactone (PCL) and incorporated electrospun nanofibers loaded with drugs and biomolecules for small joint reconstruction. We evaluated the mechanical properties of the degradable joints and the drug discharge patterns of the nanofibers. Empirical data revealed that the 3D-printed PCL joints exhibited good mechanical and fatigue properties. The drug-eluting nanofibers sustainedly released teicoplanin, ceftazidime, and ketorolac in vitro for over 30, 19, and 30 days, respectively. Furthermore, the nanofibers released high levels of bone morphogenetic protein-2 and connective tissue growth factors for over 30 days. An in vivo animal test demonstrated that nanofiber-loaded joints released high concentrations of antibiotics and analgesics in a rabbit model for 28 days. The animals in the drug-loaded degradable joint group showed greater activity counts than those in the surgery-only group. The experimental data suggest that degradable joints with sustained release of drugs and biomolecules may be utilized in small joint arthroplasty.