[Complete superficial replacement of the middle finger joint--long-term outcome and surgical technique]

Pain, weakness, malalignment and limited range of motion (ROM) at the PIP joint following arthrosis (degenerative or post-traumatic) or rheumatoid arthritis frequently require surgical treatment. PIP joint fusion or implantation of a prosthetic device are options. The purpose of this study was to report our long-term results with a surface replacement PIP arthroplasty (SR PIP arthroplasty) and the description of our operative technique. 82 prostheses were done in 60 patients between 1980 and 1999. All patients were reexamined, the average follow up was 64 months (12 to 260 months); average age was 57 years. 48 patients were operated on the right hand, 12 on the left hand. 44 patients were female, 16 were male. All patients complained of pain preoperatively. Patients were divided into three groups: A degenerative arthrosis, B posttraumatic arthrosis and C inflammatory arthritis. Active range of motion of all fingers of the operated hand, grip-strength, pain relief, joint stability or deformity and comprehensive radiographic assessment were studied. The subjective impressions of the patients were measured in four grades: very satisfied--satisfied--dissatisfied--very dissatisfied. Finally the investigators divided the overall results in: good--fair--poor. The average flexion arc was 31 degrees (maximum 15 degrees hyperextension to 95 degrees flexion) preoperatively and 47 degrees (maximum 14 degrees hyperextension to 90 degrees flexion) postoperatively. Over 70% of the patients had complete pain relief. In 12 fingers secondary procedures were necessary, usually related to soft tissue deformity and extensor tendon function. No arthrodesis was performed as a following operation. In 40 fingers a good result was achieved (49%), 25 had a fair (30%) and 17 (21%) a poor result. Our results of resurfacing PIP arthroplasty are encouraging and provide equal and usually improved motion in comparison with other joints. With experience and refinements of the operative technique our confidence in surface replacement arthroplasty has increased. For this reason we prefer this procedure for posttraumatic or degenerative arthrosis as against PIP joint fusion or silastic implants.