Factors Associated with Reoperation after Pyrocarbon Proximal Interphalangeal (PIP) Joint Arthroplasty
Jonathan Lans, MD; Bo J.W. Notermans, MD; Quirine M.J. van der Vliet, MD; Jesse B Jupiter, MD; Neal C Chen, MD
Massachusetts General Hospital, Boston, MA
Background: The rate of reoperation after PIP joint arthroplasty range from 14% to 28% and complications such as radiographic loosening (2-48%), implant breakage (0-30%), dislocation (6-16%) and stiffness (4-20%) are often described. Factors associated with reoperation are not well understood. We evaluated factors associated with reoperation after pyrocarbon PIP arthroplasty.
Materials and Methods: We retrospectively included all adult patients that underwent primary PIP pyrocarbon implant arthroplasty, between 2002 and 2016 at one institutional system in the Northeastern United States. Forty-five patients underwent 66 arthroplasties. Of these patients, 27% (n=12) had been diagnosed with inflammatory arthritis and 73% (n=33) with non-inflammatory arthritis. Arthroplasty was performed upon 10 index-, 22 middle-, 20 ring- and 2 small- fingers. To correct for a possible mutual influence of hands in bilaterally operated patients we only included fingers treated at patients initial surgery (n=54).
Results: The reoperation rate after pyrocarbon PIP arthroplasty was 33% over a median follow-up of 25 months (IQR [8.7, 54]). Indications for reoperation consisted of subluxation (n=6), stiffness (n=5), swan-neck deformity (n=3) and soft tissue complications (n=2). A second revision operation was performed in 5 fingers (9.3%). Younger age (p=0.025), male sex (p=0.017) and non-inflammatory arthritis (p=0.038) were associated with reoperation.
Conclusion: In this study, the reoperation rate after pyrocarbon PIP arthroplasty was 33%. This reoperation rate was substantially higher in patients with non-inflammatory arthritis or those that are male.
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