13 Third-generation pip joint arthroplasty: tactys Third-Generation PIP Joint Arthroplasty: Tactys

Background: Arthroplasty of the proximal interphalangeal (PIP) joint is a widely performed procedure for patients with osteoarthritis. Its use in the index finger is often discouraged due to concerns over implant longevity and stability secondary to coronal forces this digit is exposed to during pinch. Methods: We analyzed 47 consecutive index finger silastic interposition arthroplasties, performed through a dorsal approach, at a mean follow-up of 5.15 years. Results: Only 2 patients had ulnar deviation greater than 15°. The reoperation rate was 12.8%, with only 1 finger requiring arthrodesis. The mean Visual Analog Scale score was 1.1; and of the whole series, only 1 patient would retrospectively have preferred a fusion. Conclusions: Our series shows that excellent functional results and patient satisfaction can be gained using silastic PIP joint arthroplasty in the index finger. We would advocate offering this procedure, especially in lower demand patients as an alternative to arthrodesis, with the benefit of providing good pain relief while preserving movement.

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Outcomes of Surface Replacement Proximal Interphalangeal Joint Arthroplasty Through a Volar Approach: A Prospective Study

Hand ◽

10.1177/1558944716662020 ◽

2016 ◽

Vol 12 (3) ◽

pp. 290-296 ◽

Cited By ~ 5

Author(s):

Thomas E. Trumble ◽

Dennis J. Heaton

Keyword(s):

Patient Satisfaction ◽

Range Of Motion ◽

Joint Arthroplasty ◽

Extensor Mechanism ◽

Dash Score ◽

Surface Replacement ◽

Dorsal Approach ◽

Volar Approach ◽

Pip Joint ◽

Central Slip

Background: The dorsal approach to the proximal interphalangeal (PIP) joint provides the advantage of improved visualization of the articular surface, while the disadvantage of a dorsal approach is the disruption of the central slip and extensor mechanism requiring a delay in range of motion exercises. A volar approach keeps the central slip and extensor mechanism intact, allowing for early range of motion. The goal of this study was to evaluate patient outcomes of surface replacement (SR) PIP joint arthroplasty performed through a volar approach. Methods: Twenty-one patients were evaluated with primary osteoarthritis of a single PIP joint and underwent SR arthroplasty using the Stryker SR PIP joint implants. Patients included in this study were exclusively treated through a volar approach. Preoperative range of motion, coronal plan deformity, Disabilities of the Arm, Shoulder and Hand (DASH), and patient satisfaction were measured and compared with postoperative measurements using a paired Student t test. Results: The average length of follow-up was 34 months (± 9 months). Postoperative arc of motion for the PIP and distal interphalangeal (DIP) joints measured 87° (±12°) and 36° (±11°), respectively. The average improvement in PIP arc of motion was 58°, DASH score measured 14 (±5), satisfaction measured 4 (±1), and coronal plane deviation measured 2° (±2°). No evidence of implant subsidence was found on postoperative radiographs. Four patients required an extensor tendon tenolysis, and 1 patient suffered a superficial surgical site infection. Conclusion: SR arthroplasty, when performed through a volar approach, allows for early range of motion and greater improvements in arc of motion, DASH score, and patient satisfaction.

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The extensor tendon splitting approach to the proximal interphalangeal joint: do we need to reinsert the central slip?

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409352411 ◽

2009 ◽

Vol 35 (3) ◽

pp. 188-191 ◽

Cited By ~ 3

Author(s):

A. M. Afifi ◽

A. Richards ◽

A. Medoro ◽

D. Mercer ◽

M. Moneim

Keyword(s):

Extensor Tendon ◽

Proximal Interphalangeal Joint ◽

Joint Arthroplasty ◽

Interphalangeal Joint ◽

Middle Phalanx ◽

Dorsal Approach ◽

Pip Joint ◽

Central Slip ◽

Extensor Lag

Current approaches to the proximal interphalangeal (PIP) joint have potential complications and limitations. We present a dorsal approach that involves splitting the extensor tendon in the midline, detaching the insertion of the central slip and repairing the extensor tendon without reinserting the tendon into the base of the middle phalanx. A retrospective review of 16 digits that had the approach for a PIP joint arthroplasty with a mean follow up of 23 months found a postoperative PIP active ROM of 61° (range 25–90°). Fourteen digits had no extensor lag, while two digits had an extensor lag of 20° and 25°. This modified approach is fast and simple and does not cause an extensor lag.

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A Conservative Approach for Proximal Interphalangeal Joint Arthroplasty

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0541 ◽

2001 ◽

Vol 26 (3) ◽

pp. 235-237 ◽

Cited By ~ 13

Author(s):

N. R. FAHMY ◽

A. LAVENDER ◽

C. BREW

Keyword(s):

Proximal Phalanx ◽

Proximal Interphalangeal Joint ◽

Joint Arthroplasty ◽

Interphalangeal Joint ◽

Extensor Mechanism ◽

Conservative Approach ◽

Lateral Band ◽

Pip Joint ◽

Central Slip

Access to the proximal interphalangeal joint of the finger for arthroplasty is difficult without detaching its stabilizers or dividing the tendons that cross it, which then require repair and slow rehabilitation. We describe a method that conserves both, so facilitating post-operative rehabilitation. A C-shaped incision is made on the dorsum of the finger. The lateral bands of the extensor expansion are separated from the central slip proximally to the extensor hood. They are then retracted to expose the condyles of the proximal phalanx, which are excised. The PIP joint is then dislocated between the central slip and a lateral band allowing the remainder of the head to be excised. The middle and proximal phalanges are then prepared to accept the prosthesis. The prosthesis is then inserted and the joint is reduced. The lateral bands of the extensor mechanism are sutured back to the central slip before the skin is closed.

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Results of the Volar Approach in Proximal Interphalangeal Joint Arthroplasty

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500042 ◽

2018 ◽

Vol 23 (01) ◽

pp. 26-32 ◽

Cited By ~ 1

Author(s):

Scott F. M. Duncan ◽

Anthony A. Smith ◽

Kevin J. Renfree ◽

Ross M. Dunbar ◽

Marianne V. Merritt

Keyword(s):

Range Of Motion ◽

Joint Destruction ◽

Retrospective Chart Review ◽

Deep Infection ◽

Joint Arthroplasty ◽

Posttraumatic Arthritis ◽

Dorsal Approach ◽

Volar Approach ◽

Pip Joint

Background: Most hand surgeons use a dorsal approach for proximal interphalangeal (PIP) joint implant arthroplasty. However, a volar approach offers the advantage of no disturbance to the extensor mechanism, thus allowing early initiation of active range of motion. We examined our results in patients who underwent PIP joint arthroplasty via a volar approach. Methods: Using a retrospective chart review, we evaluated the outcomes of patients undergoing PIP joint arthroplasty through a volar approach between 2001 and 2005 by 3 fellowship-trained hand surgeons at our institution. The indication for surgery was PIP joint pain with radiographic evidence of joint destruction. Variables included implant type, diagnosis, affected digit(s), preoperative and postoperative range of motion, and complications. Hand therapy was initiated on postoperative day 3 or 4. Results: Over the 5 years, 25 PIP joints were replaced in 18 women and 2 men with the volar approach. Replacements consisted of 14 surface replacement prostheses, 9 pyrocarbon prostheses, and 2 silicone prostheses. The average age of patients at prosthesis implantation was 64 years (range, 39–75 years). Prostheses were placed in 1 index, 12 long, 7 ring, and 5 small digits. Average follow-up period was 33 months (range, 24–69 months). Preoperative diagnoses were osteoarthritis (14), rheumatoid arthritis (4), and posttraumatic arthritis (2). Preoperative total arc of motion averaged 42° (range, 0° extension to 80° flexion); postoperative total arc of motion averaged 56° (range, –10° extension to 90° flexion). Complications comprised 1 swan neck deformity, 1 deep infection, 1 dislocation (early), and 2 loose implants with flexion contractures. Seventeen patients had minimal or no pain at their last follow-up visit. Conclusions: PIP joint arthroplasty can be successfully implemented through a volar approach with various implant types and has outcomes similiar to the published results of the dorsal approach.

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Factors Associated with Reoperation after Pyrocarbon Proximal Interphalangeal Joint Arthroplasty for the Arthritic Joint: A Retrospective Cohort Study

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1709088 ◽

2020 ◽

Author(s):

Bo J. W. Notermans ◽

Jonathan Lans ◽

Ryan P. Ponton ◽

Jesse B. Jupiter ◽

Neal C. Chen

Keyword(s):

Reoperation Rate ◽

Proximal Interphalangeal Joint ◽

Joint Arthroplasty ◽

Factors Associated ◽

System A ◽

Initial Surgery ◽

Younger Age ◽

Pip Joint ◽

Amount Of Knowledge

Abstract Introduction The rate of reoperation after pyrocarbon proximal interphalangeal (PIP) joint arthroplasty ranges from 5.9 to 37% and complications such as radiographic loosening, deformity, dislocation, and stiffness are common. Because of the limited amount of knowledge around these problems, we evaluated factors associated with reoperation after pyrocarbon PIP arthroplasty. Materials and Methods We retrospectively included all adult patients that underwent primary PIP pyrocarbon implant arthroplasty between 2002 and 2016 at one institutional system. A total of 45 patients, with a mean age of 55 (standard deviation: 14), underwent 66 PIP arthroplasties. To address for within individual correlations, we only included fingers treated at patients’ initial surgery (n = 54) in our statistical analysis. These patients were predominantly diagnosed with noninflammatory arthritis 73% (n = 33). Arthroplasty was performed upon 10 index, 22 middle, 20 ring, and 2 small fingers. Results The reoperation rate after pyrocarbon PIP arthroplasty was 30% over a median follow-up of 25 months (interquartile range: 8.7–54). Indications for reoperation consisted of subluxation (n = 6), stiffness (n = 5), swan-neck deformity (n = 3), and soft tissue complications (n = 2). Younger age (p = 0.025), male sex (p = 0.017), and noninflammatory arthritis (p = 0.038) were associated with a higher reoperation rate. Conclusion In this study, our reoperation rate after pyrocarbon PIP arthroplasty was 30%. This study suggested that younger patients, males, and patients with noninflammatory arthritis are at higher risk of reoperation. We recommend considering these factors when selecting candidates for pyrocarbon arthroplasty. Future studies should focus on prospectively researching these factors in comparison with other implants.

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