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Midterm Results of the Vascularized Toe PIP Joint Transfer for Posttraumatic Osteoarthritis
Che-Hsiung Lee, MD
1; Yu-Te Lin, MD
21Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; 2Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
Background The use of vascularized toe joint transfer (VJT) for treating traumatic osteoarthritis of the finger's proximal interphalangeal joint (PIPJ) results in more durable improvements in pain, deformity, and range of motion (ROM) compared to other treatment methods such as arthrodesis and artificial joint transfer. In this study, we hypothesize that the mid-term outcomes regarding the efficacy of VJT are similar to those from short-term follow-ups.
Material and MethodsBetween 2007 and 2024, 25 cases diagnosed with traumatic arthritis of the finger's proximal interphalangeal joint (PIPJ) who underwent 26 vascularized toe PIPJ transfers and were followed up for more than 3 years were included in the study. Extension lag, flexion angle, and range of motion (ROM) of the transferred PIPJs were measured from the original transferred toe and at both short- and mid-term follow-ups. The Wilcoxon test was applied to analyze differences in ROM between the original toe, and the short- and mid-term follow-ups. Serial radiographic findings were analyzed to compare short- and mid-term follow-up results to determine if there were any degenerative changes in the transferred toe joints.
ResultsAmong 25 cases with 26 VJTs, the mean operative age was 29.8, with a mean follow-up of 72.3 months. The comparison between short-term (6 months) and mid-term follow-up (>3 years) showed that there was no significant difference in extension, flexion, and ROM (16.7±10.1° vs. 18.3±13.5°, p=0.417; 78.7±8.1° vs. 81.2±11.6°, p=0.087; and 62.0±14.2° vs. 62.9±16.9°, p=0.74, respectively). When comparing the short-term results to the passive ROM of the native toe, significant differences were found in extension and range of motion (16.7±10.1° vs. 6.9±6.0°, p<0.001; and 62.0±14.2° vs. 72.9±9.7°, p=0.002, respectively), but no difference was found in flexion (78.7±8.1° vs. 79.6±8.4°, p=0.604). Similar results were observed between mid-term follow-up and the native toe motion in extension and ROM (18.3±13.5° vs. 6.9±6.0°, p=0.001; and 62.9±16.9° vs. 72.9±9.7°, p=0.005, respectively). No significant differences were found between mid-term follow-up and the original toe in flexion (81.2±11.6° vs. 79.6±8.4°, p=0.152). No instances of Charcot joint degeneration were observed during the serial radiographic followup.
ConclusionVascularized toe PIP joint transfer for post-traumatic arthritis in the finger PIPJ is an effective and safe procedure that provides long-lasting results. Our midterm results demonstrated no apparent changes in extension lag, flexion, or range of motion, indicating a durable outcome. Throughout the serial radiographic follow-up, no cases of Charcot joint degeneration were detected, confirming the procedure's durable joint integrity.
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