Jennings Charles D, Livingstone Douglas P
Great Falls Orthopedic Associates, Great Falls, MT, USA.
J Hand Surg Am. 2008 Nov;33(9):1565.e1-11. doi: 10.1016/j.jhsa.2008.06.008.
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.
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.
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.
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.
使用近端指间关节（PIP）表面置换植入物评估PIP关节关节炎表面置换术（SRA）的主观和客观结果。重点关注并发症、失败的原因以及翻修所采用的技术。
这是一项对25例患者进行的43例使用PIP - SRA植入物的PIP关节表面置换术的回顾性研究。通过邮寄问卷获得主观结果。测量PIP关节和远端指间关节（DIP）术前和术后的活动范围。对X线片进行评估，查看有无下沉、假体周围透亮线、松动或应力遮挡的迹象。对需要翻修的关节进行单独分析。
平均随访时间为37个月（范围12至72个月）。平均PIP关节主动活动弧度从术前的57度增加到术后的58度，不包括2例通过关节融合术挽救的关节。平均DIP关节主动活动弧度从术前的36度降至术后的24度，不包括关节融合术的情况。满意度评级显示，26例非常满意（60%），12例相当满意（28%），5例不满意（12%）。33例患者关节疼痛改善，3例关节情况未变，7例关节情况恶化。11例（26%）关节置换失败，因疼痛需要进行大翻修（关节融合术或更换一个或两个组件）。11例翻修中有10例是由于缺乏骨水泥导致的松动。11例关节中有8例翻修手术取得了满意的结果。
PIP关节表面置换术未来具有前景。它为食指提供了硅胶关节置换术无法实现的活动度和稳定性。我们的结果与使用该植入物的其他系列研究结果相比没有显著差异，只是在我们的研究中，因松动导致的失败几乎完全与缺乏骨水泥有关。因此，在能够证明使用非骨水泥组件可取得更好的长期结果之前，我们建议在每种情况下使用PIP - SRA植入物时都使用骨水泥。无论采用何种技术或植入物，PIP关节置换术都是一项要求严格的手术，目前尚无一种技术被证明优于所有其他技术。
研究类型/证据水平：治疗性IV级
