The proximal interphalangeal joint is a bicondylar hinge joint. Disability of the proximal interphalangeal joint (PIPJ) may result from primary and post-traumatic arthrosis or inflammatory arthritis. Surgical management is indicated in patients with pain that does not respond to activity modification, analgesia, splintage and disease modifying drugs. The aim of surgical management is to relieve pain with optimal preservation of function. Special consideration should be given to the index and middle finger that will need to bear greater ulnar stress during most functions than the ulnar three digits. In the little finger greater flexion is important to aid power grip. The options for surgical treatment can be motion preserving (interposition, silicone prosthesis, resurfacing, hinged arthroplasty) or motion eliminating (arthrodesis). Resection and interposition arthroplasty is the original motion preserving intervention and has been used for over 50 years and still has a role today. Prosthetic arthroplasty is preferred for preservation of joint motion but has a less predictable outcome than arthrodesis.
The aim of joint resurfacing is to preserve ligamentous integrity and reinstate normal joint kinematics by restoring osseous anatomy. Two bearing surfaces will be considered, pyrolytic carbon on pyrolytic carbon and metal on polyethylene with discussion of surgical tips to optimise surgical outcome and limit complications. Flexible implant (silicone) arthroplasty is preferred where the soft tissue envelope is compromised, particular the collateral ligaments, or coronal plane deformity is present. The current perspectives in hinged joint replacement, resurfacing arthroplasty, silicone arthroplasty and interposition arthroplasty will be explored with reference to the local experience and current surgical literature. The outcome in PIPJ arthroplasty is influenced by diagnosis, pre-operative range of movement and surgical approach. Modes of failure include persistent pain, joint stiffness, synovitis, instability, loss of strength and implant failure. Considerations for revision of failed joint arthroplasty arthroplasty will be discussed.
Learning Objectives: - Describe the surgical anatomy, biomechanics and surgical approaches for the PIPJ.
- Identify the indications, technique and complications of silicone arthroplasty of the PIPJ.
- Identify the indications, technique and complications of resurfacing and hinged arthroplasty of the PIPJ.
- Recognize the indications, technique and complications of non-prosthetic surgery for PIPJ arthrosis: interposition arthroplasty and arthrodesis.
- Discuss techniques for revision and salvage of failed PIPJ arthroplasty.
http://www.assh.org/AnnualMeeting/program/Pages/Instructional-Course-Lectures.aspx
