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Outcomes of proximal hemiarthroplasty compare well with arthroplasty for PIP arthritis
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Arthroplasty is an established treatment for proximal interphalangeal joint arthritis, but pyrolytic carbon hemiarthroplasty is becoming a popular treatment for the condition due to the simplicity of the technique, better bone resection and reduced operating time, according to researchers.
Marcus Sagerfors, MD, and colleagues reviewed the results of 40 patients (45 fingers) with proximal interphalangeal (PIP) joint arthritis who underwent hemiarthroplasty using the PyroCarbon PIP joint replacement implant (Integra LifeSciences Corp.; Plainsboro, N.J., USA). Patients were diagnosed with either osteoarthritis or post-traumatic arthritis (30 patients) or with inflammatory arthritis (10 patients).
“Proximal interphalangeal PyroCarbon hemiarthroplasty seems to have favorable clinical outcomes. In 44 of the 45 cases studied, no implant loosening was observed,” Sagerfors said at a meeting. “It allows for limited bone resection, which could be an advantage in the case of revision surgery.”
The surgeon exposes an arthritic proximal interphalangeal (PIP) joint in preparation for an arthroplasty procedure.
Surgeons performed PIP hemiarthroplasty with a pyrocarbon prosthesis.
Images: Sagerfors M
Mid-range follow-up
The patients’ average age at the time of surgery was 56 years. Most of them were women and there was an average follow up of about 4.6 years. The ratio of women to men was 33:7, according to the study data. Sagerfors and colleagues performed a surgical technique that involved a central slip incision and preservation of the collateral ligaments.
According to Sagerfors, the optimal postoperative regimen for these patients included early mobilization. Patients wore a removable splint to prevent hyperextension of the PIP joint. They progressively increased their motion and were not allowed weight loading until 4 weeks to 6 weeks postoperatively.
Improved outcomes observed
The investigators saw significant improvement in the patients’ outcomes following surgery based on the Canadian Occupational Performance Measure, DASH and VAS scores.
According to Sagerfors, the patients’ VAS scores decreased from an average of 6.4 points preoperatively to 1.7 points after surgery.
“There also was a significant improvement in DASH scores and the Canadian Occupational Performance Measure,” he said. “The Canadian Occupational Performance Measure is a patient-centered outcome instrument with two components: performance and satisfaction. Max score is 10, and both outcome measures improved significantly in our patients.”
Radiographic outcomes were also favorable, Sagerfors said. He called those results “encouraging” with respect to implant positioning and loosening and said they compared favorably with published total PIP arthroplasty results. While most of the outcomes improved following the procedure, Sagerfors noted patients did not see improvement in every area.
“In regard to the range of motion of the PIP joint, grip strength, oppositional pinch and key pinch, no significant improvement was seen,” he said.
In terms of revisions in this group of patients, “Four cases were revised: three to arthrodesis. Three out of three healed. One was revised to a hinged silicon PIP arthroplasty,” Sagerfors said.
Indications for the surgery are still being investigated and more long-term outcomes will better validate its use, he said. – by Robert Linnehan
- Reference:
- Sagerfors M. Paper #35. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 18-20, 2014; Boston.
- For more information:
- Marcus Sagerfors, MD, can be reached at the Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden; email: marcus.sagerfors@regionorebrolan.se.
Disclosure: Sagerfors reports no relevant financial disclosures.