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Proximal Interphalangeal Joint Arthroplasty in Young Patients; An Analysis of 305 Consecutive Primary Arthroplasties
Eric R. Wagner, MD; William Robinson, MD; Matthew Houdek, MD; Steven L. Moran, MD; Marco Rizzo, MD
Mayo Clinic, Rochester, MN

Purpose: The purpose of this investigation was to assess the correlation between a young age and outcomes after PIP arthroplasty.

Methods: 305 consecutive primary PIP arthroplasties were performed in over a 14-year period, with an average age of 60 years (16-88). There were 129 arthroplasties performed in patients <60 years of age. In these younger patients (compared to patients over 60), surgical diagnoses included inflammatory arthritis (36% vs. 30%), osteoarthritis (35% vs. 53%), and post-traumatic arthritis (29% vs. 17%). Implant utilized in younger patients (vs. older patients) were pyrocarbon (64% vs. 63%), silicone (7% vs. 8%), and surface replacing arthroplasty (SRA, 29% vs. 30%). Both the younger and older groups have 3% laborers.

Results: Overall, there were 55 (18%) PIP arthroplasties that required revision surgery, including 33 (26%) in young patients (<60 years) at a mean 1.4 years. Risk of revision surgery was associated with younger ages (p=0.002). The 2, 5, and 10-year implant survival rates for the patients <60 years were 80%, 71%, and 71%, respectively, which was worse than the older patients (HR 2.10, p=0.006, Figure 1). Patients younger than 50 years had an increased risk of revision surgery (HR 1.88, p=0.04). Amongst the these younger patients (<60 years), a diagnosis of post-traumatic arthritis increased the risk for revision surgery (Table 1). The use of silicone implants decreased the risk of revision surgery (Figure 1). Complications in the younger patients included dislocation (n=13), infection (n=6), intraoperative fracture (n=9), and postoperative fracture (n=1). The risk of dislocation was increased in younger patients (p=0.02). Amongst the young patients, use of a silicone implant decreased the risk of dislocation (p<0.001). In unrevised patients at a mean 5.3 years follow-up (1-12), preoperative to postoperative pain levels significantly improved in patients <60 years (p<0.001). PIP total arc of motion did not significantly improve from 38o preoperatively to 37o postoperatively (p=0.71), and there was no significant change in grip or pinch strength. Older patients had improved PIP motion compared to patients younger than 60 years (p=0.045), but no differences in pain or pinch strength.

Summary Points: Younger age leads to worse outcomes after PIP arthroplasty, particularly in the setting of post-traumatic arthritis. Silicone implants have improved rates of revision and complications in patients <60 years. However, PIP arthroplasty predictably relieves pain and preserves motion with low complications in these younger patients.

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