Prosthetic replacement of the proximal interphalangeal joint

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Hand surgery

Background:

• Early proximal interphalangeal joint (PIPJ) replacements utilized hinged designs, limiting motion to a single axis.
• Recent advancements include anatomically designed proximal phalangeal and middle phalangeal components for PIPJ arthroplasty.
• Constrained PIPJ implants often fail at the hinge or bone interface.

Purpose of the Study:

• To review the evolution of PIPJ replacement arthroplasty.
• To discuss the rationale behind semiconstrained PIPJ prostheses.
• To highlight the importance of preserving collateral ligaments for PIPJ stability.

Main Methods:

• Literature review of PIPJ replacement arthroplasty designs.
• Analysis of biomechanical principles in joint replacement.
• Evaluation of implant limitations and failure modes.

Main Results:

• Hinged PIPJ implants had limited motion and mechanical failures.
• Anatomically designed components represent an improvement over older designs.
• Semiconstrained prostheses aim for balanced forces and improved joint mechanics.
• Silicone PIPJ implants show limitations in resisting valgus loading during pinch.

Conclusions:

• A need exists for PIPJ prostheses that balance forces and enhance stability.
• Surface replacement arthroplasty preserving collateral ligaments may offer superior PIPJ stability.
• Future PIPJ implant designs should focus on anatomical fit and biomechanical balance.