Article
Thumb IP joint arthroplasty with a surface gliding implant: One-year follow-up
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Authors
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Stephan Schindele
- Schulthess Klinik, Zürich, Switzerland
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Stefanie Hensler
- Schulthess Klinik, Zürich, Switzerland
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Miriam Marks
- Schulthess Klinik, Zürich, Switzerland
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Daniel B. Herren
- Schulthess Klinik, Zürich, Switzerland
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Osteoarthritis of the thumb interphalangeal (IP) joint is a rare condition. Standard treatment of destructed IP joints is arthrodesis, which yields adequate pain relief. However, fine motor skills, especially picking up fine objects and achieving a powerful pinch with the index finger, can be restricted. We hypothesize that joint arthroplasty might lead to better functional results in patients with destructed but preoperatively stable IP joints. Therefore, the objective of our pilot study was to analyze the clinical and patient-reported outcomes in patients up to one year after thumb IP arthroplasty.
Methods: Patients received a surface-gliding arthroplasty (CapFlex-PIP, KLS Martin Group, Tuttlingen, Germany), which was originally designed for the PIP joint, at the thumb IP joint and were assessed preoperatively as well as three months and one year after the intervention. Range of motion (ROM) of the IP joint and key pinch were measured. Patients rated their pain on a numeric rating scale (0-10) and completed the brief Michigan Hand Outcomes Questionnaire (brief MHQ, score 0-100).
Results and Conclusions: Nine patients with a mean age of 67 years were included in this analysis. Pain at rest was reduced from 5 points before the surgery to 4 points after 3 months and to 3 points a year after surgery. The preoperative brief MHQ score of 41 points improved to 67 after 3 months and to 54 points by one year. At final follow-up, ROM could be preserved with 41° and baseline key pinch strength changed from 6 kg to 5 kg and 6.5 kg at 3 months and 1 year, respectively. None of the patients developed lateral instability. In one patient, dorsal luxation of the distal component was observed 7 weeks after surgery, which was finally converted to an arthrodesis. No further complications were documented.
The use of a surface-gliding implant at the thumb IP joint presents as an adequate alternative to the function-restricting arthrodesis, particularly since pinching with the index finger requires high lateral stability at high shear forces. Arthroplasty results in a considerable reduction in pain combined with satisfactory hand function. However, the results of this pilot study have to be confirmed with a larger sample size and longer follow-ups.
