Resurfacing arthroplasty versus silicone arthroplasty for proximal interphalangeal joint osteoarthritis.

PURPOSE: To compare the outcomes of silicone proximal interphalangeal joint (PIPJ) arthroplasties to pyrolytic carbon implants in patients with osteoarthritis. METHODS: This study is a retrospective review of 41 arthroplasties in 22 patients with severe PIPJ osteoarthritis performed by a single surgeon. There were 13 patients and 22 joints in the silicone group with an average follow-up of 45 months. There were 9 patients and 19 joints in the pyrolytic carbon group with an average follow-up of 19 months. Clinical assessment included range of motion, grip strength, and deformity. Radiographs were evaluated for alignment, subsidence, and implant fracture. Patients filled out a subjective questionnaire with respect to pain, appearance of the finger, and satisfaction. Complications were recorded. RESULTS: In the silicone group, the average preoperative PIPJ range of motion (ROM) was 11 degrees /64 degrees (extension/flexion) and the average postoperative ROM was 13 degrees /62 degrees . In the pyrolytic carbon group, the average preoperative PIPJ ROM was 11 degrees /63 degrees and the average postoperative ROM was 13 degrees /66 degrees . Eleven of 20 joints in the silicone group and 4 of 19 joints in the pyrolytic carbon group had a coronal plane deformity as defined by angulation of the PIPJ > or =10 degrees . The average coronal plane deformity was 12 degrees in the silicone group and 2 degrees in the pyrolytic carbon group. The difference was statistically significant. In the silicone group, 3 of 22 joints required additional surgery. Two implants in one patient were removed and the PIPJ fused, and one implant was permanently removed for sepsis. In the pyrolytic carbon group, 8 of 19 joints squeaked, and there were 2 early postoperative dislocations and 2 implants with radiographic loosening. To date, there has been no revision surgery. Both groups had good pain relief. Patients were generally satisfied with the appearance of their joints in the pyrolytic carbon arm; however, satisfaction with appearance was variable in the silicone group. Nine of 13 patients in the silicone group and 6 of 7 patients in the pyrolytic carbon group would have the procedure again. CONCLUSIONS: Both implants provide excellent pain relief and comparable postoperative ROM. Complications were implant specific. The results of this series show promise for the pyrolytic carbon PIPJ resurfacing arthroplasty but did not clearly demonstrate superiority compared with the silicone implant.

Pyrolytic carbon proximal interphalangeal joint resurfacing arthroplasty.

PURPOSE: To evaluate the clinical results of a pyrolytic carbon resurfacing proximal interphalangeal joint (PIPJ) arthroplasty in patients with osteoarthritis. METHODS: A retrospective review of 18 PIPJ arthroplasties in 8 women with severe osteoarthritis performed by a single surgeon was completed with an average follow-up period of 13 months. Clinical assessment included range of motion (ROM), stability, and deformity. Radiographs were reviewed for evidence of loosening, subsidence, fracture, and osseointegration. Six patients, representing 16 joints, answered a questionnaire regarding pain relief, appearance, and overall satisfaction with the arthroplasty. Complications also were recorded. RESULTS: The average preoperative ROM was 10 degrees to 63 degrees, and the average postoperative ROM was 18 degrees to 71 degrees. Although the average arc of motion was unchanged, 9 joints had an increase in ROM and 9 joints had a decrease in ROM. All joints were stable laterally. Radiographic review indicated 2 joints with loosening at 4 months after surgery. Complications included 8 squeaky joints, 5 joint contractures, and 2 dislocations. Pain was relieved completely in 8 joints, and the pain rating on a visual analog scale was 3.6 out of 10 for the 8 patients who had residual pain. Patients were satisfied completely with the results of 9 joints. Although there was residual deformity in 4 joints, patients believed that 15 of 16 joints had improved in appearance. Five of 6 patients responded that they would have the surgery again. There have been no secondary procedures performed by us. CONCLUSIONS: The insertion of pyrolytic carbon implants for PIPJ arthroplasty is a technically demanding procedure, but it has the potential to achieve pain relief, stability, satisfactory ROM, and correction of the deformity; however, the results in this review were unpredictable and may not be superior to those achieved with other methods of arthroplasty. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Tendon avulsion injuries of the distal phalanx.

UNLABELLED: Mallet injuries are the result of incompetence of the terminal tendon. Most acute mallet fingers can be treated by continuous splinting of the distal interphalangeal (DIP) joint in extension for 5-6 weeks. Fracture dislocations require open reduction and internal fixation. Treatment of chronic mallet injuries must be individualized. If there is a flexible swan neck deformity, spiral oblique ligament reconstruction is indicated. For a fixed contracture, DIP joint arthrodesis is preferred. Profundus avulsion injuries, or jersey finger, seen within 10 days of injury require operative reattachment of the profundus tendon. Treatment of avulsions more than 10-14 days after injury must be individualized and depends on location of the stump (palm vs. digit), time from injury, passive mobility of the digit, and individual functional demands. Chronic avulsions, where the stump is distal to the proximal interphalangeal joint can often be advanced secondarily. Other options include no treatment, stump excision with or without DIP joint arthrodesis, or flexor tendon reconstruction with a free graft. LEVEL OF EVIDENCE: Therapeutic study, Level V (Expert opinion).