Prosthetic Arthroplasty of Non-Border Digits for Treatment of Osteoarthritis and Postraumatic Arthritis: A Systematic Review
Michael Milone, MD1; Christopher Klifto, MD1; Jacques Henri Hacquebord, MD2
1University Hospital for Joint Diseases, New York, NY; 2University of California Irvine, Orange, CA
Hypothesis: It is commonly taught that non-border digits are more appropriate for arthroplasty of the proximal interphalangeal (PIP) joint than border digits. However, we hypothesize that prosthetic arthroplasty of non-border digits is associated with an important complication profile that may not be significantly different than reported complication rates for arthroplasty of border digit PIP joints.
Methods: A computerized search of EMBASE, Medline, and Cochrane database from 1976 through 2016 was conducted for keywords of "proximal interphalangeal" and "arthrodesis or fusion or arthroplasty" and "hand or finger or finger joint". Included studies were restricted to those including 10 or more patients who underwent proximal interphalangeal joint (PIPJ) prosthetic arthroplasty or arthrodesis for osteoarthritis (OA) or post-traumatic arthritis (PTA). Titles, abstracts, and papers were then reviewed to include studies that provided data specifically on the outcomes of long and ring non-border digits.
Results: Computerized search generated 378 original articles. Of these, 10 studies reporting outcomes of arthroplasty on 196 non-border digits (95 long and 101 ring) were included in the review. 6 studies report on silicone prostheses; 3 on pyrolytic carbon; 2 Cobalt-Chrome; 1 biomeric; and 1 ceramic. There were no articles reporting outcomes for arthrodesis of the PIP joint in the setting of osteoarthritis or post-traumatic arthritis. Reports on angular deformity after silicone replacement included incidences of up to 22%m and revision surgery rate secondary to instability of 7%. A study of both silicone and pyrocarbon implants reported coronal deformity of greater than 10 ° in 40% of long and 14% of ring finger arthroplasties. Revision rates of metal surface arthroplasty in non-border digits was as high as 22-23%.
Conclusions: Existing literature on outcomes after non-border digit arthroplasty is limited; however, data suggests that complications such as revision surgery and coronal instability remain in non-border digits. Further research is necessary to compare arthroplasty in non-border and border digits to determine if complications in border digits is in fact significantly higher.
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