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Retrospective Review of 38 PIP Arthroplasties over 5 Years
Cindy Clare Ivy, MEd, BS, OT; Kevin Renfree; Ryan Odgers
Mayo Clinic, Phoenix, AZ

Introduction: Our purpose is to determine the outcomes of a postoperative therapy protocol following semi-constrained, surface replacement arthroplasties of the proximal interphalangeal joint (SC-SR PIPJ). Little has been published on results of the volar approach, which involves a simpler and less intensive therapy course. The results described in the literature report an average 27.8% complication rate.
Materials and Methods: We retrospectively reviewed 38 SC-SR PIPJ's (5 men and 33 women ) performed between 2000 and 2011. Average age was 67 (range 39-85). Eight patients had Rheumatoid Arthritis,30 osteoarthritis. Affected digits: 5 index, 19 long, 10 ring,4 small. The primary reason for surgery in all cases was pain. Surgical approach includes 3 dorsal, 6 lateral and 29 volar. All patients were splinted in a hand-based or finger-based orthosis with a 10-15 degree extension block at the PIPJ, to adjacent radial finger for 6 weeks allowing full flexion. At 6 weeks, the splint was increased to full extension and worn nightly, buddy taping to the adjacent radial digit during the day. Active flexion of MP, PIP, and DIP with blocking, composite fist, hook fist and straight fist began between post- operative days 2 -5 (>5 repetitions, 5 times per day). Patients were mailed a questionnaire to determine current level of pain, function (Quick DASH), and AROM via tracing of the finger in maximum active flexion and extension.
Results: 16/38 (42%) patients returned follow up questionnaires and drawings. Average follow up was 4.93 years (range 1-12). Average pre-operative extension / flexion was -9.25/66.86 degrees (range -10/100), and post- operative average was -15.51/68.76 (range -10/96). 19 patients had no complications. Reported average pain level was "Mild", on the QuickDASH, with 8 subjects reporting "no Difficulty". The average score for all eleven items was 31.5 (range 0-68). Complications included: 2 ulnar deviation deformities of 20 degrees on traced fingers of Index and long left hands. One of these patients didn't receive therapy at our facility. 1 rigid flexion contracture (50 degrees,lateral approach), 2 boutonnière deformities (one dorsal, one volar), 2 infections, 6 swan neck deformities (all volar), one scar hypersensitivity (volar). Range of motion was not improved, however, pain and functional use improved in all patients.
Conclusions: The volar approach with a simplified therapy program provides satisfactory outcomes for the majority of the patients needing PIP arthroplasty. Attention should be given to signs of formation of flexion contracture or hyperextension.


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