Surface replacement arthroplasty of the proximal interphalangeal joint using a volar approach: case series

To evaluate the outcomes (range of motion, function, and pain relief) of the volar approach to proximal interphalangeal (PIP) joint surface replacement arthroplasty (SRA) in active, high-demand patients.

A single surgeon performed PIP SRA in 6 joints using a volar approach. Patients with posttraumatic arthritis or osteoarthritis of the PIP joint were included. Range of motion, postoperative key pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand questionnaire data were collected. Complications, component integration, and use of cement were noted. Average follow-up was 35 months (range, 12-66 mo).

Total arc of motion averaged 33° before surgery and improved significantly in all patients, for an average postoperative arc of motion of 60°. Grip strength averaged 30 kg in the affected hand and 35 kg in the contralateral hand after surgery. Postoperative key pinch strength averaged 6 and 7 kg in ipsilateral and contralateral hands, respectively. The average Disabilities of the Arm, Shoulder, and Hand score after surgery was 14. No coronal plane deformity or postural deformity was observed. Good component integration and stability were observed in all 5 cemented joints. The only noncemented joint demonstrated progressive subsidence of both components.

The volar approach to PIP SRA can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis. The volar approach offers the advantages of maintaining the integrity of the extensor mechanism and allowing early postoperative motion. This case series demonstrates compelling data for a prospective, randomized study comparing dorsal and volar approaches to PIP SRA in patients with osteoarthritis and posttraumatic arthritis.

Therapeutic IV.