Chapter 22 Proximal Interphalangeal (PIP) Joint Replacement

Emily Altman, PT, DPT, CHT

The proximal interphalangeal (PIP) joint can be affected by posttraumatic arthritis and osteoarthritis. Impairments typically include pain, weakness, joint stiffness, and deformity. Even though patients often present with only one affected digit, the impact on the function of the entire hand is significantly impacted secondary to the quadriga effect. Because the four tendons of the flexor digitorum profundus (FDP) share a common muscle belly, a surgical procedure results in limited proximal tendon excursion (in this case, because of limited PIP flexion range of motion [ROM]). When the ulnar digits are involved, grip is impaired. When the index is involved, pinch strength and dexterity are affected. Surgical options for this condition include joint fusion, joint replacement (arthroplasty), and amputation.

Joint replacement is the only option that preserves joint motion. To date, options for joint replacement include fibrous interposition, volar plate advancement, metallic or metalloplastic hinges, or one-piece polymeric plastic hinge devices. Surgical placement of early prostheses requires extensive resection of the joint, including the collateral ligaments. This compromises the postoperative stability of the PIP joint.

At the Hospital for Special Surgery (HSS), the Avanta PIP finger prosthesis (Avanta Orthopaedics, San Diego, CA) is the option most often used. It is a semiconstrained prosthesis that more closely mimics the anatomy and kinematics of the PIP joint than other, earlier prostheses. The proximal phalanx component is a metallic cobalt chromium (CoCr) alloy, and the middle phalanx component is titanium with an ultra high molecular weight polyethylene surface. Minimal bony excision is required for placement of the Avanta prosthesis, permitting preservation of the collateral ligaments and enhanced joint stability.

Surgical Overview

• The Avanta prosthesis replaces the articular surfaces of the head of the proximal phalanx and the base of the middle phalanx.

• The surgery can be done via a dorsal, lateral, or volar approach.

1 The dorsal approach is preferred because there is better exposure of the joint and easier placement of the prosthesis.

2 Flexor tendon adherence can be a complication of the volar approach.

• With the dorsal approach, the author recommends that the central slip not be dissected from its insertion on the middle phalanx. Instead, the central slip is isolated proximal to the dorsal rim of the middle phalanx for 1 to 2 cm (via parallel incisions on either side of the central slip) then cut transversely and reflected distally, exposing the PIP joint.

1 This technique permits a larger (and therefore stronger) area of repair of the central slip/extensor apparatus once the prosthesis has been placed.

2 The distal end of the proximal phalanx and the proximal end of the middle phalanx are excised, and the implant is fitted and placed.

< div class='tao-gold-member'>

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

Total Knee Arthroplasty Contracture Release of the Elbow Extensor Tendon Repairs Dynamic External Fixation of the Proximal Interphalangeal (PIP) Joint Flexor Tendon Repairs Meniscal Repair and Transplantation

Stay updated, free articles. Join our Telegram channel

Join

Full access? Get Clinical Tree