Flexible implant resection arthroplasty of the proximal interphalangeal joint in patients with systemic inflammatory arthritis

Long-term assessmentof swanson implant arthroplasty in the proximal interphalangeal joint of the hand

“…Fair results of 222 PIP joint implants in 1973 2 and fair to good results of 424 implants in 1985 25 were reported. The clinical results of silicone implant arthroplasty for the PIP joint have been reported by Pellegrini and Burton, 26 Adamson et al, 5 Lin et al, 27 and Ashworth et al 28 ). The outcome from the studies was not as good as compared with earlier reports.…”

The hand

“…The data are summarized in Table 1. In a recent report, the relapse rates concerning corrected swan-neck deformity and button-hole deformity have been reported at 86% and 80%, respectively [2]. The same study noted a deterioration in mobility (on average 8°) in the PIP joint after arthroplasty.…”

“…It is a widely spread opinion that arthrodesis is the best alternative in this joint. If arthroplasty is selected, it is important to first correct the deformities in the MCP joints [2].…”

The Dorsal Approach to Silicone Implant Arthroplasty of the Proximal Interphalangeal Joint

“…Patients with boutonniere deformities generally experience improvement in pain, return of preoperative total active range of motion with improvement in the functional position of the arc of motion, and acceptable functional outcome. 11 Swanneck deformity, however, presents a more challenging problem, because most of these patients who have SIA of the PIP joint experience recurrence of the deformity and fail to regain a functional arc of motion. 10,11 Nonsurgical measures to maximize range of motion and control pain such as hand therapy, splinting, nonsteroidal anti-inflammatory medications, and steroid injections should generally be tried and shown to be inadequate before SIA is considered.…”

“…1,2,[5][6][7]9 Traumatic arthritis and degenerative arthritis remain the primary disease entities, 5,6,9,10 because results from the treatment of inflammatory arthropathies in the PIP joint are less reliable. 6,10,11 Patients with existing underlying extensor and intrinsic imbalance that produce swan-neck and boutonniere deformities, complicating arthritic degeneration, may still benefit from SIA. Patients with boutonniere deformities generally experience improvement in pain, return of preoperative total active range of motion with improvement in the functional position of the arc of motion, and acceptable functional outcome.…”