Background: Neuromas are caused by irregular and disorganized regeneration following nerve injury. Many surgical techniques have been described to address neuroma with varying success. The aim of this study was to evaluate predictive factors for secondary surgery after initial surgical intervention for symptomatic neuroma along with a description of the anatomical distribution of surgically treated symptomatic neuromas. Methods: Five hundred ninety-eight patients with 641 neuromas that underwent primary surgery for neuroma were identified retrospectively. The diagnosis of neuroma was based on physical examination and patient history in the medical charts. Neuromas were treated by excision, implantation in muscle or bone, excision with direct neurorrhaphy with or without nerve grafting, or other treatments. Results: The rate of secondary surgery for neuroma was 7.8 percent, and secondary operations were performed at a median of 16.1 months. Excision alone or excision with implantation into bone or muscle had higher rates of secondary surgery compared with excision and direct neurorrhaphy with or without nerve graft. Neuromas were located in the upper extremity (49.61 percent), lower extremity (46.65 percent), and the groin/trunk (3.74 percent). Conclusions: Symptomatic neuromas are located predominantly in the extremities, and surgery can improve pain, with low secondary surgery rates. Excision with direct neurorrhaphy with or without nerve grafting was associated with lower reoperation rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race ( P = .040), smoking ( P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis ( P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.

Rheumatoid arthritis has a prevalence that varies between 0.3% and 1%, with a 1:3 male to female distribution. 1,2 This leads to chronic inflammation of the metacarpophalangeal (MCP) joint and proximal interphalangeal (PIP) joint destruction causing joint deformity and pain. Although disease-modifying anti-rheumatic agents have drastically decreased joint replacement, arthroplasty remains the treatment of choice in patients unresponsive to medical treatment or when severe deformities occur. 3 Metacarpophalangeal joint replacement is favored above arthrodesis as it allows for a better hand function. Silicone implants do not depend on soft tissue support to the same extent as pyrocarbon implants do and are therefore preferred in this population. 3 Good long-term implant survival rates have been reported, and although implant fractures are common (up to 67%), they rarely require revision. 4 Reoperation rates of up to 11% have been reported. 5-9 Besides reoperation, other complications include bone erosion (14%-100%), recurrent ulnar deviation (0%-43%), and dislocation (17%). 5-7,10-15 Soft tissue balancing plays an important role in arthroplasty survival. 4 The preoperative degree of ulnar deviation has shown to be prognostic for reoperation and should be addressed intraoperatively. 16,17 Extensor mechanism 831236H ANXXX10.