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

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).

Rat perichondrium transplanted to articular cartilage defects forms articular-like, hyaline cartilage

“…We found that perichondrium transplants formed durable hyaline cartilage tissue with high proteoglycan content that filled out the articular cartilage defects including the area of active remodeling in the subchondral bone, and with time attained structure and chondrocyte marker expression patterns similar to the surrounding articular cartilage. This finding is consistent with the favorable results sometimes reported using perichondrium to resurface injured joints (36,42,43) and taken together indicate that rib perichondrium is a suitable tissue to repair injured joints.…”

“…We used a rat model allowing for tracing of transplanted cells and found that surfaces repaired with perichondrium were exclusively made up of transplanted cells and their progenies even after 112 days, thus addressing the long-standing question whether perichondrium itself have the capacity to regenerate a new joint surface or if it merely attracts invasion of chondrogenic stem cells from the bone marrow, synovial membrane or other surrounding tissues (21) , which in turn regenerate the surface. The finding that the transplanted perichondrium expanded and filled the articular cartilage defects and that the surfaces seemed to differentiate and mold to form an articular cartilage-like covering of the subchondral bone, is consistent with clinical observations that perichondrium transplantation in many cases can produce favorable long-term results if transplant detachment and other potential short-term complications are avoided (36,42) .…”

“…There is a lack of suitable tissues that can be used to resurface injured and eroded articular cartilage. Rib perichondrium has been used clinically as a tissue source, sometimes with favorable long-term results (36,42) . However, the quality of the resulting joint surfaces and the contribution of the transplanted tissues have not been investigated in detail.…”

Total Joint Arthroplasty of a Proximal Interphalangeal Joint with Proximal Metal Surface Replacement and Distal Hemi-Hamate Autograft: A Long-Term Follow-Up

“…1e3 Total joint arthroplasty with monoblock or 2-component options can maintain PIP joint motion, with risks of loosening, instability, and hardware or phalanx fractures. 4,5 Two-component arthroplasty in particular carries concerns of implant failure and joint dislocation, especially at P2. 4,5 Arthrodesis is effective for pain relief and has risks of nonunion or symptomatic hardware.…”

“…4,5 Two-component arthroplasty in particular carries concerns of implant failure and joint dislocation, especially at P2. 4,5 Arthrodesis is effective for pain relief and has risks of nonunion or symptomatic hardware. 6 We present a case of "hemi-hemi" PIP joint arthroplasty, with hemi-hamate autografting for P2 and hemiimplant for P1, in a young, active patient.…”