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AAHS #1 Proximal Interphalangeal Arthroplasty for Osteoarthritis; a Comparison of Silicone, Pyrocarbon and Surface Replacing Arthroplasty
Eric Wagner, MD; John Weston, MD; Matthew Houdek, MD; Steven L. Moran, MD; Marco Rizzo, MD
Mayo Clinic, Rochester, MN

Hypothesis: Despite the increasing prevalence osteoarthritis (OA), the surgical treatment options for proximal interphalangeal (PIP) joint OA remain arthroplasty and arthrodesis. The purpose of this investigation was to evaluate the results PIP arthroplasty in patients with OA, comparing the outcomes of 3 different implants examining survivorship, patient-related factors and clinical outcomes.

Methods: We performed a review of 169 primary PIP arthroplasties by 8 surgeons in 103 patients for osteoarthritis at our institution from 1998 to 2012. The mean age at surgery was 65 years, BMI 26, with 51% involving the dominant extremity, 84% females, 5% smokers, 2% laborers, and 6% with diabetes mellitus (DM). Implants utilized included 108 pyrocarbon, 53 surface replacing arthroplasties (SRA), and 8 silicone. Patient characteristics were similar between the pyrocarbon, SRA, and silicone groups: age (65, 65, 66), females (84%, 83%, 88%), and DM (4%, 8%, 25%), respectively.

Results: There were 26 revision surgeries performed at a mean 1.3 years postoperatively. The 2, 5 and 10 year survival rates were 88%, 82%, and 80%, respectively. The 5-year survival rates for the pyrocarbon, SRA, and silicone implants were 85%, 77%, and 88% (p=0.69), respectively (Figure 1, Table 1) silicone (blue), pyrocarbon (red) and SRA (green)). There were 8 intraoperative fractures that complicated the primary arthroplasty. Postoperatively, there were 2 periprosthetic fractures, 4 dislocations, 10 heterotopic ossification, and 7 infections. Silicone implants were associated with an increased infection rate (p=0.03). In those unrevised patients, at a mean 5.3 years (2-11) follow-up, pain levels improved from preoperatively to postoperatively (p<0.01). PIP total arc of motion did not significantly change from preoperatively (47o) to postoperatively (44o) (p=0.67). There also was no significant change in grip (p=0.34) or pinch strength (p=0.32). There were no significant differences according to implant type regarding pain (p=0.44), as well as grip or pinch strength (p>0.21). The total arc of PIP motion in the pyrocarbon, SRA, and silicone groups was 42o, 57o, and 42o (p=0.29), respectively.

Summary Points: Arthroplasty in the treatment of osteoarthritis with PIP provides predictable pain relief, with preservation of PIP motion, and reasonable medium-term implant survival There were no differences between 3 different types of implants with regards to survival, complications, pain relief or PIP motion.

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