Most PIP surface replacement implants still in use at 11-year mean follow-up

Results included a 17% failure rate at 15 years, 28 complications and average VAS pain scores of 2.

Proximal interphalangeal joint surface replacement arthroplasty appeared as successful at long-term follow-up as it was more than 10 years earlier when investigators from the Mayo Clinic reported the technique’s results at 4.5 years follow-up.

“We feel PIP surface replacement arthroplasty is a durable and reliable alternative to PIP joint arthrodesis,” said Peter M. Murray, MD, of the Mayo Clinic in Jacksonville, Fla.

During the American Society for Surgery of the Hand 63rd Annual Meeting, Murray reported statistically significantly better grip after surface replacement with proximal cobalt chrome and distal polyethylene implants in the index and long fingers vs. the ring and small fingers.

He said postoperative range of motion at final follow-up was 12° extension and 64° flexion, average.

Degenerative arthritis

Murray and colleagues retrospectively studied 36 patients who had 51 proximal interphalangeal (PIP) joints resurfaced over 32 years. Thirty patients had degenerative arthritis. Nine each had post-traumatic arthritis and rheumatoid arthritis.

Fourteen index, 17 long, 16 ring and four small fingers were resurfaced with 36 press-fit and 15 cemented procedures. The preoperative arc of motion averaged 43.7°. Patients’ mean age at surgery was 59 years and they were 71 years old, mean, at the latest follow-up.

The technique involves preparation of the proximal and middle phalanx with a series of broaches, followed by trial components. Permanent implants can be either press-fit or cemented, Murray told Orthopedics Today.

Patients infection-free

Postoperative Visual Analog Scale pain scores were 2 of 100. Murray reported no infections, but nine prostheses were loose, seven had subsided and three showed polyethylene wear.

Among the 28 complications that occurred in 10 patients, five implants failed and two patients had an amputation. “Those who underwent amputation were laborers and felt the finger was a liability,” Murray explained during his discussion of the paper.

Patients younger than 60 years of age at surgery presented with more pain at follow-up than patients who were more than 60 years of age, a difference that was statistically significant.

Thirty-six of 66 patients whose 4.5-year resurfacing results were reported in 1997 had good results, which included no loosening cases and 14° extension and 61° flexion. This was “amazingly similar to our most recent series,” Murray said.

Preoperative diagnosis had no bearing on results, he added.

For more information:
Peter M. Murray, MD, can be reached at the Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224; 904-953-2496; e-mail: murray.peter@mayo.edu. He received support from the World Arthrosis Organization and Small Bone Innovations (SBI), and has participated as a speaker for SBI.

Reference:
Murray PM, Cooney WP, Linscheid RL, Baker V. The long-term outcome of PIP joint surface replacement arthroplasty. Paper #21. Presented at the American Society for Surgery of the Hand 63rd Annual Meeting. Sept. 18-20, 2008. Chicago.