Joint replacement in 131 painful osteoarthritic and post-traumatic distal interphalangeal joints

Abstract

This study reports the results of Swanson replacement of 131 DIP joints for painful osteoarthritis and two for ongoing pain after injury. Thirty-seven arthroplasties (28 patients) were carried out with extensor tendon division and repair, and postoperative immobilization for 8 weeks. Ninety-four (60 patients) were then carried out without tendon division, allowing immediate mobilization. At assessment after a mean period of 57 months, the mean postoperative range of movement was 39°, and the mean extensor lag was 11°, with significant improvement of both in both operative groups. The severity of pain improved significantly following surgery. All but one patient were satisfied with the cosmetic result of replacement. The overall complication rate was 7/131(5%). Three joints developed cellulitis and one developed osteomyelitis, requiring subsequent fusion. Two joints had subsequent fusions because of persistent lateral instability and marked ulnar deviation and one had a persistent mallet-type deformity, corrected by tendon shortening.

Silicone arthroplasty versus screw arthrodesis in distal interphalangeal joint osteoarthritis

“…A large series investigating 131 DIP joint arthroplasties 57 months after surgery noted a larger ROM of 39° compared with our study with a lower extension lag of 11° (Sierakowski et al., 2012). The tendon-sparing approach used in one of their groups did not create a significant difference compared with the group undergoing a tenotomy approach.…”

“…Besides pain and function, the appearance of the hand plays an important role in patients with hand OA and impacts their daily life (Liu et al., 2016). Although our patients receiving arthroplasty reported less satisfaction with the appearance of the DIP joint, Wilgis (1997) and Sierakowski et al. (2012) showed an improved appearance in 89% and 99% of their patients, respectively.…”

“…There is controversy regarding the level of stability achieved with DIP joint arthroplasty. While Sierakowski et al. (2012) rated all DIP joint arthroplasties as stable due to the intramedullary parts of the Swanson prosthesis and flexor digitorum profundus tendon activation, 56% of arthroplasties were rated as clinically unstable by Wilgis (1997).…”

“…The largest series investigating patients with DIP joint arthroplasties showed that pain was significantly decreased on average 4.8 years after surgery and that average ROM was 39°. The complication incidence was 5% (Sierakowski et al., 2012). A few smaller series also describe good results and an active ROM of 30°–40° (Brown, 1989; Schwartz and Peimer, 1998; Snow et al., 1977; Wilgis, 1997; Zimmerman et al., 1989).…”

Thumb interphalangeal joint replacements with silicone and surface gliding implants. A case report

“…Arthrodesis is the preferred intervention for osteoarthritis (OA) of the thumb interphalangeal (IP) joint (Rizzo, 2006). However, if preservation of joint range of motion is desired, replacement with implant arthroplasty is an alternative and has been documented for distal IP joints of the long fingers (Sierakowski et al., 2012). We describe the technique of thumb IP arthroplasty using a silicone (Swanson, Wright Medical Group N.V., Cham, Switzerland) and surface gliding implant (CapFlex, KLSMartin group, Tuttlingen, Germany) in one patient.…”