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

Abstract

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.

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

“…The improvement in ROM following PIPJ arthroplasty seen in our series is also similar to what has been previously reported. 16,17 The complication rate seen in our series (8.33%) is similar to previous reported case series 6,7,18 ; however, a more recent case series reported a much higher complication rate (37%) with no improvement in ROM. 19 A recent meta-analysis reported higher rates of complications; however, the involved studies were limited to pyrocarbon and ceramic prostheses only.…”

“…All surgeries were carried out successfully, without the need for sedation/anesthesia or tourniquet, indicating that the WALANT technique is suitable for PIPJ arthroplasty. The mean postoperative VAS score reported in our patients (2.3) is similar to the mean score reported by Richards et al, 7 who used local anesthesia and a digital tourniquet. The improvement in ROM following PIPJ arthroplasty seen in our series is also similar to what has been previously reported.…”

“…5,6 The overall complication rate for silicone arthroplasty has been reported at 11% (soft tissue complications being most common) with a revision rate of 3.3% to 12.8%. 6,7 High rates of migration and loosening have also been reported. 5 Despite this, PIPJ arthroplasty remains a common procedure for PIPJ OA as it preserves joint motion, improves symptoms, and retains the possibility of arthrodesis at a later date if symptoms persist or complications arise.…”

Is it useful to replace the proximal interphalangeal joint at the index finger? Analysis of prospective 5-year outcomes

“…It also has a higher risk of postoperative complications than arthrodesis (Vitale et al., 2015). Nonetheless, a recent study highlighted good functional outcomes of index finger arthroplasty with an acceptable revision rate (Richards et al., 2022). We routinely use PIP arthroplasties in the index finger to preserve range of motion (ROM).…”

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

“…However, arthrodesis leads to complete loss of joint motion and compromises the joint function which is less tolerated in young and active patients. Implant arthroplasty is able to provide a good pain relief while preserving ROM, thereby granting excellent functional outcomes with high patient satisfaction [11] . However, finger prostheses still failed to match the success achieved by artificial hip and knee prostheses.…”