Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Abstract

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.

Factors Associated with Reoperation after Pyrocarbon Proximal Interphalangeal Joint Arthroplasty for the Arthritic Joint: A Retrospective Cohort Study

“…However, in our study the index fingers underwent the least reoperations of all fingers. 23 Additionally, a recently published review puts the contraindication for performing arthroplasty of the index finger under discussion. They found that there is no difference in overall deformity, instability, and complication rate between long and index fingers.…”

“…The overall reoperation rate following silicone PIP arthroplasty is 14% compared with 30% following pyrocarbon arthroplasty. 23 Besides that additional surgeries increase overall costs, based on Medicare reimbursement, the costs for a pyrocarbon PIP implant are $1,890 versus $406 for a silicone PIP implant. 24 The reason why posttraumatic arthritis was associated with reoperation is unclear, but possible explanations may be preoperative joint deformity, injury to soft tissues including the capsule, incompetent collateral ligaments, or heavier loading of the fingers compared with those with inflammatory arthritis.…”

Low-cost procedure for deformity correction in rheumatoid hands

“…15 Disadvantages of silicon joints arthroplasty include: it is technically difficult, expensive, (cost 120 British Pounds/joint, manufactured by Osteotec Ltd, Building 81, Greenham Business Park, Newbury, Berkshire, UK RG19 6HW) not universally available and associated with a possibility of implant fracture/extrusion, infection, dislocation, silicone synovitis, extensor lag and tendency for worsening outcome in long-term. 16 , 17 Implant arthroplasty while preserving motion has an implant complication rate of 42% at 10 years and 66% at 17 years. Revision rates were 17% at 10 years.…”

What’s New in Hand and Wrist Surgery

“…However, there was an overall rate of complications of 34% and a 16% rate of revision surgical procedures 21 . Another study of 114 PIP joint silicone arthroplasties also showed a high reoperation rate of 14%, with risk factors being a surgical procedure on the index finger, smoking status, non-Caucasian race, and arthroplasty performed for posttraumatic arthritis 22 .…”