A Prospective, Randomized Comparison of 3 Types of Proximal Interphalangeal Joint Arthroplasty
ABSTRACT For surface replacement arthroplasty in proximal interphalangeal joint osteoarthritis, titanium-polyethylene (TI) and pyrocarbon (PY) implants are frequently used. However, their superiority in comparison to the silicone (SI) spacer has not been established. The purpose of this study was to compare these 3 types of implants with regard to outcome.
A prospective, randomized, multicenter trial was performed. A total of 43 patients (62 proximal interphalangeal joints) had surgery in the 3 participating centers, and each patient was randomly allocated to one of the 3 groups (TI, PY, SI). Range of motion (ROM) and strength were measured before surgery; pain and disability self-assessment and radiographic analysis were also completed. The same examination protocol was planned for 3 months, 6 months, and 1, 2, and 3 years after surgery, but some follow-up visits did not take place due to patient death or poor compliance.
The mean follow-up time at the final follow-up was 35 ± 3 months (range, 30-41 mo). All implant types led to significant pain reduction at rest and at load. Tip pinch strength was slightly improved by all 3 devices at the 3-year follow-up. No significant improvement in ROM for silicone or resurfacing implants was found. However, when comparing the highest ROM values reached after surgery, the resurfacing devices tended to show superior joint motility compared to silicone spacers, albeit only temporarily and not significantly. Sixteen explantations were necessary: 2 of 18 SI (11%), 7 of 26 TI (27%) and 7 of 18 PY (39%) implants had to be removed. An additional 4 secondary surgical procedures were performed in group TI.
Surface replacement arthroplasty devices showed a tendency for a temporarily superior maximum postoperative ROM, but markedly higher postoperative complication and explantation rates were observed compared to the silicone spacer implantation.
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ABSTRACT: Clinical results of the PyroCarbon proximal interphalangeal joint replacement are inconsistent with various complications reported. To address this, in vitro testing was conducted using finger joint simulators. Two PyroCarbon proximal interphalangeal prostheses were tested in a lubricant of dilute bovine serum to 5 × 10(6) cycles of flexion-extension (90°-30°) with dynamic forces of 10 N applied. At intervals of 3000 cycles testing ceased and a static load of 100 N was applied to simulate gripping. In addition, two 'control' prostheses were immersed alongside the test prostheses to account for lubricant absorption. Wear and roughness averages (Ra) were measured every 1 × 10(6) cycles. Minimal wear for all of the components was measured with a negligible increase in Ra for most of the components. One condyle of one component increased in Ra over the 5 × 10(6) cycles with a value above the recommended 50 nm. Unidirectional marks were visible on the condyle from micrographs, consistent with an abrasive wear mode. © IMechE 2015.05/2015; 229(5):362-8. DOI:10.1177/0954411915581410
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ABSTRACT: To evaluate the long-term results of proximal interphalangeal (PIP) joint surface replacement arthroplasty for arthritis using the SR PIP implant (Small Bone Innovations, New York, NY). This is a long-term retrospective analysis of results in 39 of 43 joints first reported in 2008. Subjective results were based upon a mailed questionnaire. Active range of motion was measured by a certified hand therapist, and x-rays were obtained to analyze changes occurring since the first study. The average follow-up time was 9.3 years. The average active PIP joint arc of motion in the present cohort of patients went from 64° at the first report (2008) to 56° at this time. Radiographic comparisons revealed no major changes since the first study. Ten of 11 revisions were done for pain due to loosening and were performed at an average of 20 months after the primary procedure. No further revisions were necessary in the interim. Overall, subjective measures of satisfaction and symptomatic and functional improvement remained unchanged. Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the PIP joint. Long-term subjective and objective outcomes are comparable to those reported using other implants. This and other studies suggest that this procedure is not appropriate for most rheumatoid joints. In the interim between studies, we saw a reduction in the average PIP joint arc of motion, although this change did not reach statistical significance. Our original revision incidence of 26% has not changed. Subjective evaluation and radiologic findings did not change between studies. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.The Journal Of Hand Surgery 01/2015; 40(3). DOI:10.1016/j.jhsa.2014.11.015 · 1.66 Impact Factor
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ABSTRACT: To evaluate the short-term clinical and radiographic outcome of a silicone proximal interphalangeal (PIP) joint implant using a volar approach in patients with primary osteoarthritis. We retrospectively reviewed 36 proximal PIP joints that were replaced with Avanta silicone implants in 26 patients. Inclusion criteria were diagnosis of primary osteoarthrtitis of the PIP joint and failure to respond to conservative treatment. Clinical asessment included range of motion, patient satisfaction, and pain scores. The Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire was administered at final follow-up. Radiographs were reviewed for alignment and implant fracture. Complications were also recorded. After an average follow-up of 18 months (range, 12-60 mo), pain relief was markedly reduced in all patients, decreasing from a mean score of 7.2 preoperatively to 0.4 postoperatively. The arc of active motion of the PIP joint improved from 33° to 72°. Satisfaction averaged 4.8 on a 5-point Likert scale, and all patients stated they would repeat the surgery. The median final average Quick-Disabilities of the Arm, Shoulder, and Hand score was 7 (range, 4-12). Radiograph review showed 2 implant fractures at 1 and 2 years after surgery, respectively, but without clinical changes. The average deformity in the coronal plane changed from 12° (range, 8° to 18°) preoperatively to 4° (range, 3° to 8°) postoperatively, whereas the average flexion contracture changed from 18° (range, 10° to 30°) to 0° (all patients achieved full active extension). No other complications were observed. No revision surgery has been needed to date. The volar approach to PIP joint silicone arthroplasty offers the advantages of maintaining the integrity of the extensor mechanism, providing pain relief, and improving postoperative range of motion with minimal complications. However, further research is needed to determine the long-term efficacy of this implant. Therapeutic IV.The Journal of hand surgery 05/2014; DOI:10.1016/j.jhsa.2014.03.033 · 1.66 Impact Factor