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The Impact of Osteoporosis on Proximal Interphalangeal Arthroplasty Outcomes; a case-control matched cohort
Eric R. Wagner, MD; Robinson, MD; John Weston, MD; Steven L. Moran, MD; Marco Rizzo, MD; Bayard C. Carlson, MD
Mayo Clinic, Rochester, MN
Purpose: The objective of this study was to assess how osteoporosis affects outcomes after proximal interphalangeal (PIP) arthroplasty outcomes, stratifying by diagnosis and implant choice.
Methods: Forty-one PIP arthroplasties performed over a 14-year period were performed in patients had a diagnosis of osteoporosis and were being treated with bisphosphonates. The mean preoperative DEXA score was 3.0 (-1.4 to -5.2), with 72% having a score <-2.5. Surgical diagnoses include inflammatory arthritis (n=15), osteoarthritis (n=20) and post-traumatic (n=5). There were 40 were non-constrained implants (34 pyrocarbon and 6 surface replacing arthroplasties (SRAs) and only 1 constrained silicone implant. Bone graft was used in 5 arthroplasties. This group was matched 1:5 ratio with a control group without osteoporosis according to age (66 vs. 66), female gender (92% vs. 92%), and diagnosis (inflammatory 26% vs. 27%, OA 61% vs. 61%, post-traumatic 12% vs. 13%).
Results: In patients with osteoporosis, there were 10 (24%) revision surgeries performed at There were 5 revision surgeries performed at a mean 5.6 months postoperatively. Etiologies included for revision surgery included pain with limited motion (n=7) and dislocation (n=3). The 5 and 10-year survival rates were 75%, and 75%, respectively. Pyrocarbon implants had an increased risk of implant failure in osteoporotic patients (p=0.04) (Table 1). Surgical diagnosis does not have an effect on implant survival. The DEXA score also did not correlate with risk for revision surgery (p=0.61). Complications included 3 3 intraoperative fractures, dislocations, but no postoperative fractures or infections. When compared to the control group without osteoporosis, there a non-significant increased risk of revision, with 5 and 10-year survival rates of 85% and 83% (p=0.10) (Figure 1), but no difference in complications, including intraoperative fractures (p=0.55). In those unrevised patients, at a mean 4.1 years (1-9) follow-up, preoperative to postoperative pain levels significantly improved (p<0.01). PIP total arc of motion did not significantly improve from 43o preoperatively to 52o postoperatively (p=0.25), and there was no significant change in grip or pinch strength. There were no differences between those with or without osteoporosis regarding pain, PIP motion or pinch strength.
Conclusion: PIP arthroplasty performed in the setting of osteoporosis produces predictable pain relief and motion preservation with reasonable low complications. However, there is a slightly increased risk of implant failure compared to those without osteoporosis, especially when using a pyrocarbon implant. This series highlights the need for improved surgical techniques or implant technology in the setting of osteoporotic bone.
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