Shifting the paradigm: ankylosis arthroplasty for the proximal interphalangeal joint with a novel collateral ligament reconstruction

Abstract

Silicone arthroplasty for proximal interphalangeal joint ankylosis is rarely performed, partly due to the potential for lateral joint instability. We present our experience performing proximal interphalangeal joint arthroplasty for joint ankylosis, using a novel reinforcement/reconstruction technique for the proper collateral ligament. Cases were prospectively followed-up (median 13.5 months, range 9–24) and collected data included range of motion, intraoperative collateral ligament status and postoperative clinical joint stability; a seven-item Likert scale (1–5) patient-reported outcomes questionnaire was also completed. Twenty-one ankylosed proximal interphalangeal joints were treated with silicone arthroplasty, and 42 collateral ligament reinforcements undertaken in 12 patients. There was improvement in range of motion from 0° in all joints to a mean of 73° (SD 12.3); lateral joint stability was achieved in 40 out of 42 of collateral ligaments. High median patient satisfaction scores (5/5) suggest that silicone arthroplasty with collateral ligament reinforcement/reconstruction should be considered as a treatment option in selected patients with proximal interphalangeal joint ankylosis. Level of evidence: IV