Proximal Interphalangeal Joint Arthroplasy Following Injury

ABSTRACT

Ten patients (five males and five females) underwent proximal interphalangeal joint arthroplasty performed for either an irreparable injury or the sequelae of trauma between September 2000 and January 2003, following the availability of the latest generation of constrained and nonconstrained prostheses. Average patient age was 38 years (range: 15-75 years). Six dominant hands and four nondominant hands were involved. Injuries included two fracture dislocations, one pilon fracture, two late-presenting dorsal dislocations, and five patients with post-traumatic arthritis. One injury was to the index finger, three to the middle finger, and six to the ring finger.

An unconstrained bicondylar prosthesis was used for the index finger and a constrained plastic prosthesis preflexed to 15º was used in the remaining joints. Average follow-up was 13 months (range: 4-31 months). All patients had complete or nearly complete pain relief with no required pain medication beyond the immediate postoperative period. All patients returned to their previous job with minimal or no restrictions (seven patients) or to their previous activity level (three patients). Motion was excellent in five patients, good in four patients, and fair in one patient. Grip strength was slightly compromised in eight patients (<25% loss compared to the uninvolved hand) and moderately decreased (25%-50% loss) in two patients with satisfactory results.

The design changes of the newest generation of proximal interphalangeal joint prostheses provide good to excellent early results for salvage of irreparable injuries and symptomatic post-traumatic arthritis of the proximal interphalangeal joint with prospects for greater longevity than their predecessors. The bicondylar prosthesis allows index finger proximal interphalangeal joint arthroplasty, which was previously not feasible with plastic prostheses, owing to their instability during pinching activities.