Comparison of Volar and Dorsal Approaches for PIP arthroplasty
Geneva Tranchida, MD1; Lauren Erickson, MS2; Christina Ward, MD3; Scott Allen, MD1; (1)University of Minnesota, Minneapolis, MN, (2)HealthPartners Institute, Bloomington, MN, (3)Univeristy of Minnesota, Minneapolis, MN
Previous studies demonstrated that proximal interphalangeal (PIP) joint arthroplasty often results in pain relief without a significant change in range of motion (ROM). Historically, surgeons often performed PIP arthroplasty through a dorsal approach that disrupts the extensor mechanism. In contrast, the volar approach does not require extensor mechanism disruption nor prolonged immobilization, which may improve ROM. While early studies comparing these approaches yielded equivocal results, several recent studies have shown greater gains in ROM with the volar approach. We sought to determine differences in post-operative ROM and complication rates between the volar and dorsal approach for PIP arthroplasty.
Materials and Methods:
We retrospectively reviewed the charts for all patients > 18 years old who underwent PIP arthroplasty from 2000-2015 and had a minimum of 30 days of clinical followup. We recorded demographic data, surgical approach, pre- and post-operative ROM, duration of immobilization, time and duration of hand therapy, duration of follow up, and major and minor complications. Equal variance t-tests and chi-square tests were used to compare mean change in ROM, final ROM, and complication rates. Pearson correlation was used to determine the effect of duration of immobilization and time to OT initiation on final ROM.
The volar approach (VA) group had a better pre-op ROM (49¡) compared with the dorsal approach (DA) group (30¡, p=0.013). While there was no difference in final ROM between VA and DA groups (56¡ and 54¡ respectively, p> 0.05), there was a greater gain in ROM after the dorsal approach (25¡ vs 2.7¡, p = 0.017). There was no statistically significant difference in overall incidence of complications (volar: 37.8%, dorsal: 30.3%; p> 0.05) or revision (VA: 15.6%, DA: 17.1%; p>0.05). Although the VA group had a higher incidence of major complication rates (24.4% vs 16.3%; p>0.05), this was not statistically significant. Similarly, there were no differences in average duration of immobilization, time to OT initiation, or number of OT session and none of these correlated with final ROM.
Comparing these approaches, there was no difference in duration of postoperative immobilization or time to OT initiation. There was no statistical difference in incidence of complications or revision rates between the volar and dorsal approach groups. Patients who underwent a dorsal approach exhibited worse preoperative ROM, but the final ROM between the two groups was similar.
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