The Long-term Results of Proximal Interphalangeal Joint Arthroplasty of the Osteoarthritic Index Finger

Reported Outcomes and Outcome Measures in Proximal Interphalangeal Joint Arthroplasty: A Systematic Review

Purpose: There is a lack of scientific consensus on the best arthroplasty implant option for proximal interphalangeal joint (PIPJ) arthritis, due to diversity in outcome reporting and measurement methods. The development of a standardized core outcome set (COS) and standard outcome measures could mitigate this issue. This study catalogs the reported outcomes and outcome measures found in PIPJ arthroplasty studies, which can be used in the first step of developing a COS. Methods: A database search of MEDLINE, EMBASE, and Web of Science (January 1, 2010, to March 10, 2021) was performed to retrieve studies that reported outcomes of the 3 most common primary PIPJ arthroplasty implants: silicone, pyrocarbon, and metal-polyethylene. The primary objectives of this study include reported outcomes and outcome measures. Secondary objectives include clinimetric properties of outcome measures, study design, and implant types. Results: Fifty articles met inclusion criteria. Of the included studies, 41 (82%) were case series, 8 (16%) were cohort studies, and 1 (2%) was a randomized control trial. Thirty-three unique outcomes were identified. Fifteen (46%) outcomes were clinician-reported and 26 (79%) were patient-reported. Eighteen unique outcome measures were identified. Of the outcome measures, 15 (83%) were patient-reported, 1 (6%) was clinician-reported, and 2 (11%) were reported by both patients and clinicians. Conclusions: Substantial heterogeneity was found in reported outcomes and outcome measures across studies evaluating PIPJ arthroplasty, impeding knowledge translation. The development of a COS for PIPJ arthroplasty is necessary to help compare and pool data across studies, and advance scientific knowledge.

Proximal Interphalangeal Joint Arthroplasty Using the Wide-Awake Local Anesthesia No Tourniquet Technique

BACKGROUND

Proximal interphalangeal joint (PIPJ) osteoarthritis is a common condition that results in pain, stiffness, and loss of function in the affected hand. Proximal interphalangeal joint arthroplasty is an effective treatment option when conservative methods have failed. The wide-awake local anesthesia no tourniquet (WALANT) technique to perform surgery carries advantages such as lack of tourniquet discomfort, reduces the staffing and costs associated with anesthesia and sedation, and allows faster recovery. We aimed to determine whether the WALANT technique was safe and effective in the context of PIPJ arthroplasty.

METHODS

Patients were enrolled retrospectively from January 2015 to October 2020 by examining operating theater records and surgeon logbooks. Electronic patient records were examined to obtain patient data. Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and Visual Analog Scale (VAS) for pain were sent by post to patients-with a separate DASH and VAS for each digit operated on.

RESULTS

Twenty-nine PIPJ arthroplasties were carried out using WALANT technique by 3 different surgeons all using the dorsal approach. All cases were successfully carried out as day-case procedures. There was a significant correlation with increasing VAS and increasing DASH score. Proximal interphalangeal joint arthroplasty improved range of motion from 28.9 ± 5.5° to 79.4 ± 13.3° (P < .0001). Two cases developed complications related to surgery.

CONCLUSIONS

Our study is the first to report the use of WALANT to perform PIPJ arthroplasty, and shows comparable results with traditional methods. Larger, multicenter prospective trials are required to determine the efficacy of this technique and to quantify its economical benefit.

Proximal interphalangeal joint prosthetic arthroplasty

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.

Soft tissue interpositional arthroplasty as a treatment of proximal interphalangeal joint arthritis in resource-limited health care facility: A case report

Introduction

Treatment of choice for posttraumatic arthritis in proximal interphalangeal (PIP) joints has remained a controversial subject. There is a lack of consensus regarding the optimal approach and treatment options for PIP joint arthritis. In this study, we report our experience in management of PIP joint arthritis using soft-tissue interpositional arthroplasty.

Case presentation

A 12-year-old female, right-handed, complains of stiffness on the left ring finger. There was a flexion deformity accompanied by limitation on both active and passive flexion-extension range of motion (ROM) of the PIP joint. Soft tissue interpositional arthroplasty was then performed using middle phalanx periosteum as interpositional material. Postoperative follow-up showed improvement in both active and passive ROM of PIP joint, improvement in joint function, and a good pain relief. Overall, the patient was satisfied with the outcomes of the procedure.

Clinical discussion

Arthrodesis, implant arthroplasty, and interpositional arthroplasty are the treatments of choice for stiff fingers that are caused by bone problems. In this study, we report a case of PIP joint arthritis treated with interpositional arthroplasty. It was able to provide ROM improvement and good functional results. Periosteum is used as an interposition material because of its in-situ nature thereby reducing donor site related morbidity and postoperative complications. In addition, the use of the periosteum makes this procedure relatively inexpensive and makes it a suitable treatment of choice in limited resources areas.

Conclusion

Soft tissue interpositional arthroplasty shows promising results as a treatment option for arthritis of PIP joint, especially in limited resource areas.

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Interpositional arthroplasty provides good clinical outcomes for PIP joint arthritis.

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The use of periosteum as interposition material reduces morbidity and complications.

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Interpositional arthroplasty is a proper treatment option for limited resource area.