Complications of Small Joint Arthroplasty
Section snippets
Silicone
Silicone implants have been used for the PIP joint for more than 30 years. There are very large series reporting excellent results.3 In general, very few series report improvement in range of motion after surgery. Pain relief is generally excellent and improvement in function is clear. It is difficult with a radiolucent implant to determine if there is a fracture of the implant. Indirect radiographic parameters include subluxation/dislocation of the joint, subsidence, or bony fracture (Fig. 1).
Metacarpophalangeal joint
Implant arthroplasty has also been extensively reported for treating painful MCP joints. Several varieties of implants have been used ranging from traditional silicone, to a modified silicone prosthesis, to pyrocarbon implants.
Distal interphalangeal joint
Arthroplasty of the DIP joint is a much less commonly reported procedure. A review of the literature reveals very few case series describing this operation. Of the series available, the investigators describe using a flexible silicone joint implant placed through a dorsal approach. This technique requires incising and repair of extensor tendon. Snow and colleagues40 published a series of 7 joints replaced in 4 hands in 1977 for osteoarthritis. These investigators advocated the procedure;
Summary
All implants in each joint can lead to complications. Although not proven in the literature, implant arthroplasty does give better function than arthrodesis. Despite the risks of implant fracture and instability, silicone arthroplasty does not lead to silicone synovitis and is a reliable procedure. Pyrocarbon implants are showing some promise, particularly in the osteoarthritic patient. It is too early to make predictions regarding the use of other implants until more long-term studies are
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Cited by (42)
Proximal Interphalangeal Joint Arthroplasty for Fracture
2023, Hand ClinicsProximal interphalangeal joint arthroplasty with the Tactys® prosthesis: Clinical and radiological outcomes at a mean 3.1 years’ follow-up
2022, Hand Surgery and RehabilitationCitation Excerpt :Rates of implant fracture and instability are high with silicone prostheses, although these remain the gold-standard in various recent meta-analyses and literature reviews [15,16]. No implant is currently able to provide a painless, entirely mobile, and stable finger without any complications [15–19]. The Tactys® prosthesis (DJO, Guildford, United Kingdom, distributed in France by Mathys, Sélestat, France) is an anatomical gliding modular non-constrained prosthesis made of chrome-cobalt alloy, polyethylene, and titanium.
Metacarpophalangeal Joint Pyrocarbon Arthroplasty for Osteoarthritis: An Analysis of 44 Arthroplasties
2022, Journal of Hand SurgeryFinger joint denervation in hand osteoarthritis: Indications, surgical techniques and outcomes. A systematic review of published cases
2020, Hand Surgery and Rehabilitation
The authors did not receive any outside funding or grants in support of this work.