Arthrodesis of the proximal interphalangeal joint of the finger – a systematic review

Abstract

Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results. Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies. A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring. All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.

Arthrodesis of the Proximal Interphalangeal Joint of the Finger—A Biomechanical Study of Primary Stability

“…Although all the used implants have proven themselves to be capable of fusing the PIP joint of the finger in several clinical studies—as shown in the systematic review of Millrose et al—some are used in special circumstances [ 12 ]. For example, plates—regardless of whether they are of a fixation or locking design—show a tendency to lead to tendon adhesions—especially when applied near or on a joint, which might impair the function of the hand [ 20 ].…”

“…Leibovic et al, stated after a clinical study in 1994, that techniques with compression of the fusion site could provide more reliable results [ 23 ]. The primary nonunion rate was highest using Kirschner wires, intermediate using tension band wires, and lowest using Compression screws; in a systematic review on this topic, this assumption could not be proven [ 12 ]. One possible explanation was that when combining the techniques into an analysis of compression versus non-compression, more advanced techniques such as tension bands were included—which show a higher complication rate than the compression screw—and therefore no evidence could be found.…”

“…A recent systematic review on the PIP joint arthrodesis showed that all these procedures lead to union in a reasonable percentage of patients and periods of time [ 11 ]. Newer published techniques, which all rely on the principles of established techniques, have not been able to prove themselves superior [ 8 , 12 ]. Due to the wide variety of surgical techniques for the arthrodesis of this joint, we can state that an optimal procedure has not yet been introduced.…”

Minimum 5-Year Follow-Up Assessment of Volar Plate Interposition Arthroplasty for Post-Traumatic Osteoarthritis in Proximal Interphalangeal Joints

“…Joint denervation for post-traumatic osteoarthritis has been shown to be effective for proximal interphalangeal joints with an improved numeric pain scale and disabilities of the arm, shoulder, and hand questionnaire [5]. In a painful joint with severe functional limitations, surgical treatment options include joint fusion [9], implant arthroplasty [9][10][11][12][13], and free vascularized joint transfer [14,15]. Arthrodesis, including K-wires, tension band wiring, plates, and headless compression screws, may provide excellent pain relief and stability for those joints in the end stage of osteoarthritis [9].…”

“…In a painful joint with severe functional limitations, surgical treatment options include joint fusion [9], implant arthroplasty [9][10][11][12][13], and free vascularized joint transfer [14,15]. Arthrodesis, including K-wires, tension band wiring, plates, and headless compression screws, may provide excellent pain relief and stability for those joints in the end stage of osteoarthritis [9]. Nevertheless, the complete loss of joint motion may cause some functional limitations [16].…”