gms | German Medical Science

Objective: Silicone arthroplasty of the PIP-joint is still the golden standard since the introduction of Swanson 40 years ago. Revision after failed proximal interphalangeal joint arthroplasty is challenging. Besides the conversion into a joint fusion, revision implant arthroplasty is a possible option. It is the purpose of this study to analyse the results of Silicone revision arthroplasty after failed Silastic implants in the PIP joint.

Methods: In a retrospective case series out of 612 Silicone PIP joint arthoplasties in a 10 year period, 34 revision arthroplasties in 27 patients were analyzed. Nineteen (70.4%) of these patients with a total of 23 joints could be seen for follow up examination. All primary and all revision implants were Silicone arthroplasties, all but one with the original Swanson design. The indication for revision surgery included pain, joint deformity and limited range of motion. Patient evaluation measurement included the recording of mobility, strength and residual deformity as well as pain scoring and patients satisfaction.

Results: The revision rate in this series was 5.5%. Average time between revision and primary surgery was 3,8 years (0.4-19.4 years). The average follow up after revision was 3.2 years (0.6-8.3 years). Intraoperatively 12/37 implants were completely intact, no case showed significant Silicone synovitis. The active range of motion before the primary arthroplasty procedure was 56° (±17.6°), before revison 47° (±26.0°) and after the revision 46° (±20.0°). Those 9 joints with which had been revised due to unsatisfactory mobility after the primary joint replacement showed an average range of motion before the revison of 30° (±15.0°) and after the revision procedure at time of follow up of 50° (±18.3°). Fifteen of 23 revised joints were without pain, the average pain score (VAS 1 to 10) at follow up was 1.5. Patient’s satisfaction on a scale from 0 (very satisfied) to 10 (completely dissatisfied) averaged 3.1. Seventeen joints had a residual ulnar deviation of 16°. Three implants showed radiographical signs of implant failure at follow up.

Conclusion: The revision rate after Silicone PIP arthroplasty in this series is low. In cases of failure of the primary procedure Silicone revision arthroplasty gives overall satisfactory results. In cases of severe limitation of ROM after the primary arthroplasty a revision and replacement of the Silicone implant could gain better mobility. However pre-existing ulnar deviation could not be sufficiently corrected with the revision procedure. The best indication for implant revision surgery at the PIP level remains pain.