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An Evidence-Based Approach to Proximal Interphalangeal Joint Arthroplasty
Timothy Andrew Ade, MD; Southern Illinois University; Michael W. Neumeister
Southern Illinois University School of Medicine, Springfield, IL

Background: Proximal Interphalangeal (PIP) joint arthroplasty is used to treat patients with rheumatoid arthritis, primary osteoarthritis, and posttraumatic arthritis. These patients often present with joint pain, stiffness, decreased range of motion, and deformity which have detrimental effects on functional grasp and pinch strength. There appears to be consensus that arthroplasty of the proximal interphalangeal (PIP) joint leads to successful outcomes. Arthroplasty can be performed with a variety of implants, including use of a silicone spacer and pyrocarbon arthroplasty. In the evolution of arthroplasty, pyrocarbon joint arthroplasty is a relatively recent modification that attempts to address improved joint stability in addition to strengthening the PIP joint. A complete review was performed to summarize the published evidence on silicone and pyrocarbon PIP joint arthroplasty to identify an evidence-based approach to this treatment method.
Methods: A review of the PubMed and Cochrane Library databases were performed to find all reports of silicone and pyrocarbon PIP joint arthroplasty. Outcomes were evaluated based on range of motion, pain relief, grip strength, quality of life measures, cost, and complications. A level of evidence was given to each study in accordance with the American Society of Plastic Surgeons' Rating Levels of Evidence.
Results: Of the initial 223 reports, 26 studies were identified (5 comparative studies, 8 pyrocarbon case series, and 13 silicone case series) and represented a total of 1403 joints. After evidence review, 1 study represented level II evidence, 4 studies were level III evidence, and the remaining 21 studies represented level IV evidence. Both types of joint replacements provided similar post-operative measure of grip strength, range of motion, pain relief, and quality of life measures. Generally, pyrocarbon arthroplasty had a higher frequency complications, surgical revisions, and salvage procedures over silicone arthroplasty.
Conclusions: From the limited collection of higher level evidence, PIP joint arthroplasty provides adequate relief of arthritis symptoms. The evidence does not indicate a superior joint replacement method between silicone and pyrocarbon joint replacement. However, there is concern for pyrocarbon arthroplasty because of higher rates of complication and surgical revision over silicone arthroplasty. Future high level evidence studies are needed to guide treatment modalities and should focus on standardized outcome measures.


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