Factors Associated with Reoperation after Silicone 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: Reoperation rates after silicone PIP arthroplasty range from 0% to 26% and complications such as implant breakage (0-30%), dislocation (6-16%) and stiffness (4-20%) are often described. However, factors associated with reoperation are not well understood. The aim of this study was to identify factors associated with reoperation after silicone PIP arthroplasty.
Materials and Methods: We included all adult patients that underwent primary PIP arthroplasty at one institutional system in the Northeastern United States between 1992 and 2016. We identified 102 patients that underwent 144 PIP arthroplasties. Arthroplasty was performed in 1 thumb, 17 index-, 47 middle-, 41 ring- and 23- small fingers. The most common preoperative diagnosis was post-traumatic arthritis (n=38, 37%) followed by primary degenerative arthritis (n=33, 32%) and inflammatory arthritis (n=30, 29%). One patient was treated for a flexion contracture due to a cerebral palsy. To correct for a possible mutual influence of hands in bilaterally operated patients we only included fingers treated at patients initial surgery (n=129). All explanatory variables with a p-value <0.10 in bivariate analysis were included in a generalized estimating equation.
Results: The reoperation rate in this cohort was 23%, over a median follow up of 16 (IQR [3.6, 60]) months. A second revision surgery was performed in 11 (8.5%) fingers. Indications for revision surgery included stiffness (n=9), implant breakage (n=8), nonunion (n=2), deformity (n=2) and soft tissue complications (n=6). Multivariable analysis showed that younger age at initial surgery was independently associated with a higher risk of reoperation (P=0.014). Most common complications consisted of stiffness (29%), deformity (29%) and extensor lag (20%). The 2-, 5- and 10-year implant survival rates were 92%, 88% and 60%, respectively.
Conclusion: We observed a reoperation rate of 23% for silicone PIP joint arthroplasty. Analysis showed that younger age at initial surgery is independently associated with reoperation.
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