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Short Term Results of Cemented Surface Replacement Arthroplasty in the Proximal Interphalangeal Joint
Craig Thomas Gillis, DO; Luis Vela, DO
Samaritan Health Services, Corvallis, OR

Introduction: In 1979, the “surface replacement arthroplasty (SRA)” was reported to improve proximal interphalangeal (PIP) joint mechanics by limiting bone removal, preserving the collateral ligaments and unloading the component stems. PIP arthroplasty is an excellent option in alleviating pain and preserving motion, but revision rates range from 26 to 58%. We retrospectively reviewed our short term experience with a cemented SRA in the PIP (formerly AVANTA, now Small Bone Innovations ™ , Morrisville, PA USA) placed via a dorsal approach, from 2009 through 2014.
Materials and Methods: After institutional review board approval, a retrospective chart review was undertaken for all SRA PIPs from 2009 to 2014. Inclusion criteria was any patient who underwent an SRA PIP. No patients were excluded. Data included follow up duration and pre and postoperative range of motion in the PIP joint.
A dorsal approach was utilized with the collateral ligaments elevated proximally and the central slip split longitudinally. Placement of the prosthesis was undertaken in accordance with the manufacturer’s technique. Repair of the central slip and collaterals was performed through drill holes with 4-0 coated, braided polyester suture.
Aggressive postoperative therapy was instituted within one week with protective bracing followed by gentle progression with range of motion for 12 weeks with a certified hand therapist.
Results: Eleven female patients with 13 SRA PIPs were included in the data set. The average age at replacement was 63 years (range 55 to 79). Follow up averaged 8 months (range 2 to 30). Six (46%) replacements were in the middle finger, six (46%) were in the ring finger, and one was in the small finger (8%). Range of motion improved 4o (p = .30) (See Table 1). Complications included an intraoperative fracture of the middle phalanx (1/13), stiffness requiring capsulotomies (2/13), and one patient with a recurring volar dislocation requiring subsequent fusion. Total reoperation rate was 23% (3/13) for all arthroplasties.
Conclusions: Despite previous series reporting variable postoperative range of motion from 30o to 60o , we have demonstrated an average arc of motion slightly improved over other reports (650 versus 470). We feel this is a result of aggressive supervised hand therapy focused on protected range of motion. Further research is anticipated to elucidate the optimal management of the SRA PIP.

Table 1. Passive range of motion measurements.

  Preoperative (degrees) Postoperative (degrees)
Flexion 73 80
Extension 12 15
Arc of motion 61 65

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