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Outcomes after PIP Arthroplasty Dislocation; an analysis of 28 consecutive cases
Eric R. Wagner, MD; Wanderman, MD; Steven L. Moran, MD; Marco Rizzo, MD;
Mayo Clinic, Rochester, MN

Purpose: There remains a paucity of information regarding the treatment outcomes of dislocation after proximal phalangeal (PIP) arthroplasty. The purpose of this study was to assess the outcomes of surgical and nonoperative treatment modalities for PIP arthroplasty dislocations.

Methods: Out of 380 PIP arthroplasties collected in a single institution's total joints registry, there were 28 (7%) dislocations, including 8% of all non-constrained arthroplasties (total n=345). Demographics for those who suffered a dislocation included 75% females and mean age of 55 years. Eight dislocations involved border digits, with diagnoses including osteoarthritis (n=8), inflammatory arthritis (n=9), and post-traumatic arthritis (n=11). Only non-constrained implants, including pyrocarbon (n=22) and surface replacing arthroplasty (SRA, n=6), experienced dislocations. The analysis included treatment of dislocations after primary (n=21) and revision (n=7) PIP arthroplasty. Dislocation was defined as radiographic evidence of PIP prosthetic dislocation diagnosed by a fellowship trained hand surgeon.

Results: Out of the 28 dislocations, the initial treatments included 4 closed reduction and splinting, 15 revision arthroplasties, 1 PIP arthrodesis, 2 soft tissue procedures, and 1 amputation. Additionally, 5 patients chose to have to treatment for their PIP dislocations. Of the 4 that underwent closed reduction and splinting, all failed nonoperative management secondary to recurrent instability and eventually required either soft tissue (ST) stabilization (n=1) or revision arthroplasty combined with stabilization procedures (n=3). Ultimately, 17 underwent revision arthroplasty and 4 underwent soft tissue stabilization procedures. All 4 of those who underwent ST procedures had recurrent instability, with 3 requiring revision procedures. Of the 17 revision arthroplasties, 5 (29%) had repeat instability, with 4 (24%) requiring revision surgery. Components used in revision PIP arthroplasty included pyrocarbon (n=9), SRA (n=1) and silicone (n=7). Patients who underwent ST procedures had an increased risk of repeat instability (p<0.01) and revision surgery for instability (p=0.049) compared to revision arthroplasty. After revision arthroplasty, the 2 and 5 years survival-free of repeat instability was 72%, while the 2 and 5 year survival free of re-revision surgery was 62%. There was no difference in repeat instability when comparing the 3 components.

Conclusion: Treatment of PIP dislocation is a very technically challenging endeavor, with high rates of repeat instability requiring repeat intervention. Closed reduction with splinting and soft tissue stabilization procedures have an increased risk of failure compared to revision arthroplasty.

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