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Scientific Articles   |    
Long-Term Outcomes of Proximal Interphalangeal Joint Surface Replacement Arthroplasty
Peter M. Murray, MD1; Ronald L. Linscheid, MD2; William P. Cooney, III, MD2; Vickie Baker, RN1; Michael G. Heckman, MS1
1 Department of Orthopedic Surgery (P.M.M. and V.B.) and Division of Biostatistics (M.G.H.), Mayo Clinic Florida, 4500 San Pablo Road South, Jacksonville, FL 32224
2 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Department of Orthopedic Surgery (P.M.M. and V.B.) and Division of Biostatistics (M.G.H.), Mayo Clinic Florida, 4500 San Pablo Road South, Jacksonville, FL 32224
Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905
Investigation performed at the Mayo Clinic, Rochester, Minnesota, and the Mayo Clinic, Jacksonville, Florida

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jun 20;94(12):1120-1128. doi: 10.2106/JBJS.J.01375
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Abstract

Background: 

Surface replacement arthroplasty is a reconstructive alternative for the treatment of pain and deformity due to osteoarthritis and rheumatoid arthritis of the proximal interphalangeal joint of the finger. This retrospective study was performed to examine long-term outcomes of proximal interphalangeal joint prosthetic surface replacement with a proximal cobalt-chromium (CoCr) and distal ultra-high molecular-weight polyethylene component over thirty years at a single institution.

Methods: 

Sixty-seven prostheses were implanted in forty-seven patients between 1974 and 2007. The mean duration of follow-up was 8.8 years. There were fifty joints (75%) with osteoarthritis and seventeen (25%) with rheumatoid arthritis. Fifty-six prostheses (84%) were implanted via a dorsal approach, forty-eight (72%) were cemented, and nineteen (28%) were press-fit. Postoperative evaluation, consisting of a clinical history and examination, radiographs, the Short Form-36 (SF-36) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, and a visual analog scale (VAS) pain score, was performed for thirty-six patients. Demographic, surgical, and implant failure data were obtained from the medical charts of eleven patients (sixteen implants) who had died prior to the time of postoperative follow-up.

Results: 

At the time of follow-up, the median total active proximal interphalangeal joint motion was 40°. Eight prostheses had failed, yielding a cumulative incidence of implant failure of 3% at one year, 8% at three years, 11% at five years, and 16% at fifteen through twenty-five years. Prostheses implanted via a volar approach failed more often than those implanted via a dorsal approach (relative risk: 6.59, p = 0.004). The failure rate did not differ significantly between patients with rheumatoid arthritis and those with osteoarthritis (p = 0.17). The median VAS pain score at the time of follow-up was 3 (of a maximum of 100). There were twenty-two complications in fourteen patients, resulting in four interphalangeal fusions and two amputations. There were no infections.

Conclusions: 

Proximal interphalangeal surface replacement arthroplasty is a reliable treatment alternative for pain and deformity due to proximal interphalangeal joint osteoarthritis and rheumatoid arthritis. At the time of long-term follow-up, pain was minimal and joint motion was similar to preoperative levels.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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