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Early Outcomes of Pyrolytic Carbon Proximal Interphalangeal Joint Arthroplasty Using the Lateral Approach
Lorenzo Pacelli, MD; Mersadies Martin, MD; Diana Kivirahk, OTR/L, CHT; Andy Myerson, PA-C; Botte Michael, MD
Orthopaedic Surgery, Scripps Clinic, La Jolla, CA

Hypothesis: Many approaches have been described for proximal interphalangeal (PIP) arthroplasty in the literature. The dorsal approach for PIP joint arthroplasty is commonly used for its technical ease, access to extensor mechanism for correction of central slip abnormalities and preservation of the collateral ligaments. The lateral approach has gained popularity in the recent years as it avoids the postoperative complications with the dorsal route in particular extensor tendon imbalance. We report on the functional and clinical outcomes of pyrolytic carbon arthroplsty (PCA) for PIP joint arthroplasty using the lateral approach.

Methods: 26 primary Pyrocarbon PIP joint arthroplasties in 19 patients (14 females, 5 males, mean age, 61 range 24-83 years) were reviewed. Equal distribution of digits were seen. All were performed via a lateral approach (mid-axial) to the PIP joint from January 2008 to present with a mean follow-up of 13.2 months. Clinical outcome parameters were determined preoperatively and at the most recent postoperatively. Subjective outcome measures included the patient satisfaction scores and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Clinical evaluations included PIP joint range of motion, grip strength, pinch strength, and radiography. Surgery for any complication was counted as a failure.

Results: Two out of 26 implants underwent a revision surgery. One joint showed radiograpghic subsidence and required revision arthroplasty. One joint developed significant ankylosis requiring caspulectomy and release. No joints developed collateral ligament instabilty or squeaking. Postoperatively, the DASH score, pain and pinch strengths showed significant improvement. The grip strength and active and passive arc of motion improved postoperatively with near statistical significance.

Summary Points: PIP joint arthroplasty is a successful procedure in the treatment of arthritic PIP joint pain. To our knowledge, this is the first study presenting early functional outcomes of the lateral approach for PCA of the PIP joint. Based on functional and clinical outcomes, the lateral approach has many advantages over the other approaches. Success of the lateral approach has long-term potential as measured by patient satisfaction, functional outcome measures, range of motion, and strength.

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