Surface replacement arthroplasty of the proximal interphalangeal joint using the PIP-SRA implant: results, complications, and revisions.

PURPOSE

To evaluate the subjective and objective results of surface replacement arthroplasty (SRA) for arthritis of the proximal interphalangeal (PIP) joint using the PIP-SRA implant. Emphasis is placed on causes of complications, failures, and techniques used for revision.

METHODS

This is a retrospective review of 43 surface replacement PIP joint arthroplasties performed in 25 patients using the PIP-SRA implant. Subjective results were obtained through a mailed questionnaire. Pre- and postoperative ranges of motion were obtained for PIP joints and DIP joints. X-rays were evaluated for signs of subsidence, periprosthetic radiolucency, loosening, or stress-shielding. Joints requiring revision were separately analyzed.

RESULTS

The average follow-up time was 37 months (range, 12 to 72 months). The average active PIP joint arc of motion went from 57 degrees before surgery to 58 degrees after surgery, excluding 2 joints that were salvaged with arthrodesis. The average active DIP joint arc of motion went from 36 degrees before surgery to 24 degrees after surgery, excluding arthrodeses. Satisfaction rating revealed 26 very satisfactory (60%), 12 fairly satisfactory (28%), and 5 not satisfactory (12%). Thirty-three patients rated their joint pain better, 3 joints were unchanged, and 7 were worse. Eleven (26%) arthroplasties failed, requiring major revision (arthrodesis or replacement of 1 or both components) for pain. Ten of 11 revisions were due to loosening associated with the lack of cement. Revision procedures produced satisfactory results in 8 of 11 joints.

CONCLUSIONS

Surface replacement arthroplasty of the PIP joint holds promise for the future. It offers motion and stability for the index finger unattainable with silicone arthroplasty. Our results do not differ notably from those of other series using this implant, except that failures due to loosening in our study were almost exclusively associated with the lack of cement. Therefore, we recommend using cement with the PIP-SRA implant in every case until superior long-term results can be demonstrated using uncemented components. Proximal interphalangeal joint arthroplasty is an exacting procedure no matter what technique or implant is used, and no one technique has yet been proven superior to all others.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.