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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Distal interphalangeal joint osteoarthritis: Silicone arthroplasty versus screw arthrodesis

Meeting Abstract

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  • presenting/speaker Lea Estermann - Schulthess Klinik, Zürich, Switzerland
  • Lisa Neukom - Spital Bülach, Zürich, Switzerland
  • Miriam Marks - Schulthess Klinik, Zürich, Switzerland
  • Silvia Kündig - Schulthess Klinik, Zürich, Switzerland
  • Daniel B. Herren - Schulthess Klinik, Zürich, Switzerland
  • Stephan Schindele - Schulthess Klinik, Zürich, Switzerland

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-568

doi: 10.3205/19ifssh1060, urn:nbn:de:0183-19ifssh10609

Published: February 6, 2020

© 2020 Estermann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The objective of this study was to compare the outcomes of distal interphalangeal joint (DIP) silicone arthroplasty with DIP screw arthrodesis.

Methods: Patients with a DIP silicone arthroplasty and matched patients with an arthrodesis were examined on average 4.4 years after surgery. Active range of motion (ROM) of the DIP joint and sensibility of the fingertip (Semmes-Weinstein monofilament test) were measured. Patients rated joint pain on a 0-10 numeric rating scale as well as their subjective perception of sensibility, stability and appearance of the affected joint. Patients also completed the Michigan Hand Outcomes Questionnaire (MHQ, score 0-100) to measure hand function. Pre- and final postoperative radiographs were analysed for joint axis deviations and implant situation.

Results and Conclusions: In total, 48 patients were included with 39 arthroplasties and 42 arthrodesis. At follow-up, mean ROM of the DIP silicone arthroplasties was 27° (±15). Arthroplasty patients also had significantly better objective and subjective fingertip sensibility (p<0.01), but were less satisfied with their finger appearance (p<0.05). Overall, patients in both groups were equally satisfied with the treatment result and hand function was similar (MHQ scores were 73 and 77 for arthroplasty and arthrodesis patients, respectively; p=0.22). Pain was only minimal for all patients with an average score below 1. Five arthroplasties (13%) required conversion to an arthrodesis 1-5 years after the primary surgery due to instability and axis deviation in 3 joints and joint irritation in 2 joints. Five arthrodesis screws (12%) were removed between 6 and 12 months after surgery.

DIP silicone arthroplasty is a motion preserving alternative to DIP arthrodesis with high patient satisfaction, although finger aesthetics is superior in fusions. Based on the results, arthroplasty is best indicated in patients with little preoperative joint axis deviation, whereas arthrodesis might be the better choice for unstable and deviated joints with gross osteophytes. Since DIP arthroplasty enables more functionality in pinching and grasping small objects, we recommend this intervention if more function is required in preoperatively stable joints with sufficient collateral ligaments and no axis deviation. DIP arthrodesis should be favored in unstable and/or deviated joints to overcome the aesthetic inadequacies of arthroplasty.