The palmar approach for PIP-arthroplasty according to Simmen: results after 8 years follow-up.

BACKGROUND

Alloarthroplasty of the proximal interphalangeal joint is indicated for patients with osteoarthritis, an inflammatory disease of the joint. According to the current literature, implants made of silicone are not inferior to newer implants and the complications are well known. Therefore, focus should be shifted to the operative approach to improve the results.

METHODS

Eleven silicone arthroplasties in 7 patients with arthritis and 35 silicone arthroplasties in 23 patients with osteoarthritis were reviewed after 15.6 months and after 105.3 months. All implants were inserted using the palmar approach according to Simmen. We compared the pre- and postoperative arc of motion, pain, and strength, and present postoperative complications and satisfaction.

RESULTS

Patients with arthritis showed a gain in range of motion of 36° and patients with osteoarthritis of 39°. No implant failure occurred, and one revision was performed,. Average extension lag over all operated joints of patients was 2.8°. No swan-neck deformity or extensor tendon adhesion was observed. There was no significant difference in the postoperative results between patients with osteoarthritis and arthritis or between first and second follow-up.

CONCLUSION

Silicone arthroplasty restores the functionality of proximal interphalangeal joints in patients with osteoarthritis and inflammatory joint disease. Using a palmar approach, the surgeon can reach palmar and dorsal osteophytes. The extensor mechanism stays intact reducing the risk for extensor lag and other complications compared to the dorsal approach. The results do not change significantly between 1 and 8 years postoperatively.