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

Hand ◽  
2016 ◽  
Vol 12 (3) ◽  
pp. 290-296 ◽  
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.

scholarly journals Outcomes of Surface Replacement Proximal Interphalangeal Joint Arthroplasty Using the Self Locking Finger Joint Implant: Minimum Two Years Follow-up

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 637-645 ◽  
Author(s):  
Issei Komatsu ◽  
Yoshiya Arishima ◽  
Hirotomo Shibahashi ◽  
Toshihito Yamaguchi ◽  
Yoshitaka Minamikawa
Keyword(s):  
Patient Satisfaction ◽  
Range Of Motion ◽  
Grip Strength ◽  
Joint Arthroplasty ◽  
The Self ◽  
Dash Score ◽  
Surface Replacement ◽  
Vas Score ◽  
Pip Joint

Background: The Self Locking Finger Joint (SLFJ) implant is a new type of surface replacement implant. The purpose of this study was to evaluate midterm clinical outcomes of the proximal interphalangeal (PIP) arthroplasty with the SLFJ implant. Methods: We retrospectively studied 26 PIP joint arthroplasties using the SLFJ implant in 17 patients with osteoarthritis or posttraumatic osteoarthritis. Preoperative and postoperative range of motion, grip strength and key pinch, radiographic findings, and complications were evaluated. The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS) score, course of pain, and patient satisfaction were obtained. Results: The mean follow-up time was 44 months (range, 24-76 months). The average active PIP joint arc of motion improved from 36° before surgery to 44° after surgery. Grip strength and key pinch showed no statistical difference between preoperative and postoperative assessments. The average DASH score and VAS score improved from 40 to 15 and from 5 to 1, respectively. Overall patient satisfaction was 94%. Ninety percent of implants showed osteointegration, and there were no radiographic signs of migration and loosening. Three joints (12%) showed abnormal heterotopic bone formation. Four joints (15%) had secondary surgery—1 joint needing joint head and socket replacement and 3 joints needing contracture release. Conclusions: Our minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion. The SLFJ implant showed good osteointegration. Further longer-term prospective studies with various types of currently available implants are needed.

Results of the Volar Approach in Proximal Interphalangeal Joint Arthroplasty

2018 ◽  
Vol 23 (01) ◽  
pp. 26-32 ◽  
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.

scholarly journals Surface Replacement Proximal Interphalangeal Joint Arthroplasty: A Case Series

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 669-674
Author(s):  
Pieter W. Jordaan ◽  
Duncan McGuire ◽  
Michael W. Solomons
Keyword(s):  
Patient Satisfaction ◽  
Range Of Motion ◽  
Retrospective Review ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Surface Replacement ◽  
Significant Difference

Background: In 2012, our unit published our experience with a pyrocarbon proximal interphalangeal joint (PIPJ) implant. Due to high subsidence rates, a decision was made to change to a cemented surface replacement proximal interphalangeal joint (SR-PIPJ) implant. The purpose of this study was to assess whether the change to a cemented implant would improve the subsidence rates. Methods: Retrospective review of all patients who had a cemented SR-PIPJ arthroplasty performed from 2011 to 2013 with at least 12 months follow-up. Results: A total of 43 joints were included with an average follow-up of 26.5 months. There was a significant ( P = .02) improvement in arc of motion with an average satisfaction score of 3.3 (satisfied patient). Subsidence was noted in 26% of joints with a significant difference in range of motion ( P = .003) and patient satisfaction ( P = .001) between the group with and without subsidence. Conclusions: The change to a cemented implant resulted in satisfied patients with an improvement in range of motion. The rate of subsidence improved but remains unacceptably high.

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

2009 ◽  
Vol 35 (3) ◽  
pp. 188-191 ◽  
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.

A Conservative Approach for Proximal Interphalangeal Joint Arthroplasty

2001 ◽  
Vol 26 (3) ◽  
pp. 235-237 ◽  
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.

Surface replacement trapeziometacarpal joint arthroplasty – early results

2009 ◽  
Vol 34 (6) ◽  
pp. 748-757 ◽  
Author(s):  
A. PENDSE ◽  
A. NISAR ◽  
S. Z. SHAH ◽  
A. BHOSALE ◽  
J. V. FREEMAN ◽  
...  
Keyword(s):  
Joint Arthroplasty ◽  
Dash Score ◽  
Surface Replacement ◽  
Trapeziometacarpal Joint ◽  
Early Results ◽  
Asymptomatic Patients ◽  
The Mean ◽  
Quick Dash ◽  
Tendon Interposition

This study reviews the results of Surface Replacement Trapeziometacarpal (SR TMC, Avanta®, San Diego, CA) total joint arthroplasty. Fifty patients (62 joints) were included in the study. Forty-three patients (54 joints) were seen at final follow up. Seven patients (eight joints) were interviewed over the phone. Seven patients were revised to trapeziectomy and ligament reconstruction with tendon interposition, five for aseptic loosening and two for dislocation. At final follow up, the mean Quick DASH score was 30.4 and the Sollerman Score was 77.3. Radiological review of the surviving 55 joints showed subsidence of four trapezial components in asymptomatic patients. Cumulative survival rate was 91% at 3 years. Eighty-five percent of the patients were satisfied with the outcome of their treatment.

scholarly journals Surface Replacement Arthroplasty Using a Volar Approach for Osteoarthritis of Proximal Interphalangeal Joint: Results After a Minimum 5-Year Follow-up

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 81-86
Author(s):  
Ken Shirakawa ◽  
Masahiko Shirota
Keyword(s):  
Extensor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Surface Replacement ◽  
Main Risk Factor ◽  
Volar Approach ◽  
Surface Replacement Arthroplasty ◽  
Replacement Arthroplasty ◽  
Pip Joint ◽  
The Relationship

Background: Surface replacement arthroplasty (SRA) through a volar approach for the proximal interphalangeal (PIP) joint can preserve the integrity of the extensor tendon, which allows early range of motion (ROM) exercise postoperatively. However, a few reports have shown that the PIP ROM tends to decline with longer follow-up. The goal of this study is to assess the results of at least 5 years of follow-up of SRA through a volar approach and also to investigate the cause of deterioration of ROM with time after SRA through this approach. Methods: Eleven fingers with degenerative osteoarthritis that underwent SRA through the volar approach were examined. ROM of the PIP joint preoperation, 1 year after the surgery, and at final follow-up was measured and statistically analyzed. Also, the relationship between PIP ROM and the osteophyte developed postoperatively was examined. Results: The average follow-up period was 7.3 years. The average PIP ROM of the PIP joints was 52.3° preoperatively, 54.1° at 1 year postoperatively, and 31.1° at the final follow-up. PIP ROM at the final follow-up was significantly decreased compared with that preoperatively or at 1 year postoperatively. Also, the development of an osteophyte was negatively correlated with the ROM of the PIP joint at the final follow-up. Conclusions: PIP ROM after SRA through a volar approach has the tendency to deteriorate with a longer follow-up. Development of an osteophyte is considered to be a main risk factor of deterioration in the cases of SRA through a volar approach.

Post-Operative Contracture of the Proximal Interphalangeal Joint after Surface Replacement Arthroplasty Using a Volar Approach

2016 ◽  
Vol 21 (03) ◽  
pp. 345-351 ◽  
Author(s):  
Ken Shirakawa ◽  
Masahiko Shirota
Keyword(s):  
Major Complication ◽  
Proximal Interphalangeal Joint ◽  
X Rays ◽  
Surface Replacement ◽  
Osteophyte Formation ◽  
Volar Approach ◽  
Surface Replacement Arthroplasty ◽  
Replacement Arthroplasty ◽  
Central Slip

Background: Postoperative contracture as a major complication of surface replacement arthroplasty (SRA) remains an unresolved problem. Contracture after SRA can occur early in the postoperative period due to mechanical dysfunction, and tardy contracture where ROM declines with time postoperatively is also reported. Methods: 13 fingers with degenerative osteoarthritis and two fingers with post-traumatic arthritis where SRA was performed using volar approach were involved. Contracture was defined as limited ROM of less than 35 degrees. Cases were then categorized into two groups according to time of onset of contracture; early contracture and tardy contracture. Characteristic findings of postoperative X-rays in each contracture group were examined. Required procedures and efficacy of any further surgery was also reviewed. Results: Early contracture was observed in three cases, all of which suffered intra-operative fracture or fragility of the central slip insertion on the dorsal rim of the middle phalanx. This was observed in a further two cases, both of which deteriorated to tardy contracture. Tardy contracture was observed in five cases, and the average ROM was 63 degrees preoperatively, 48 degrees one year postoperatively and 21 degrees at the most recent follow-up, or at the time of the second surgery. In the three cases, development of osteophyte formation on the volar aspect of the proximal head component was observed on the follow-up X-rays. Required further surgeries were resection of the volar plate in two cases, resection of ossification in one and resection of the osteophyte in two. The results of further surgeries were mediocre in all but one case. Conclusions: This study showed that intra-operative fracture or fragility of the central slip insertion was a risk factor for postoperative contracture after SRA, and that development of osteophyte formation can be a cause of deterioration in ROM of the PIP joint.

Closed Reduction and Percutaneous Pinning for Treatment of Proximal Interphalangeal Joint Pilon Fractures

Hand ◽  
2021 ◽  
pp. 155894472199077
Author(s):  
Farid Najd Mazhar ◽  
Paniz Motaghi
Keyword(s):  
Range Of Motion ◽  
Closed Reduction ◽  
Pinch Strength ◽  
Dash Score ◽  
Wide Range ◽  
Pip Joint ◽  
The Mean ◽  
Quick Dash ◽  
Pilon Fractures

Background: Proximal interphalangeal (PIP) joint pilon fractures are among the challenging hand injuries, which are often associated with a wide range of complications. This study aimed to report the clinical and radiological outcomes of closed reduction and percutaneous Kirschner wire (KW) insertion with or without bone cement application (for the fabrication of an external fixator) in the treatment of PIP joint pilon fractures. Methods: Twenty pilon fractures underwent closed reduction and percutaneous KW fixation through a modified technique. At the end of the follow-up period, 3 questionnaires—Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Visual Analogue Scale for pain, and Patient-Rated Wrist Evaluation—were completed. The radiological outcome was assessed by radiography. Range of motion, and grip and pinch strength were measured. Results: The mean follow-up period was 14.57 ± 4.03 months (range, 12-20 months). The mean range of motion of PIP at the end of the follow-up period was 89.64° ± 10.82° (range, 65°-100°). The mean difference in the range of motion in the contralateral side was 21.4° ± 13°. The mean of the Quick DASH score was 13.50 ± 2.92 (range, 11-21). Two patients had residual articular malalignment, and 3 patients had angular or rotational malunion. Conclusion: By treating pilon fractures with the proposed technique, we achieved a satisfactory outcome. The acceptable articular and axial alignment was achieved in 75% of patients, and complications were low. The flexibility of percutaneous KW insertion and handmade external fixators makes these approaches convenient for treating PIP joint pilon fractures.

scholarly journals Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26 years

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Muder ◽  
Nils P. Hailer ◽  
Torbjörn Vedung
Keyword(s):  
Primary Outcome ◽  
Statistical Significance ◽  
Surface Replacement ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Two Component ◽  
Pip Joint

Abstract Background The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Methods We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint. Results The median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8). Conclusion In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants. Level of evidence III (Therapeutic).

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