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[Proximal interphalangeal joint replacement: A comparison between the volar and dorsal approach]
L Natera1, E Moya-Gómez1, C Lamas-Gómez e l1
1Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
Introduction:
Arthropathy of the proximal interphalangeal (PIP) joint symptoms is very restrictive, and in some cases arthroplasty is required. In most of the reported series of PIP silicone arthroplasty, the technique described is the dorsal approach. As far as we know, the role of the volar approach in PIP arthroplasty has still not been adequately assessed.
Objectives:
To retrospectively review the patients who had PIP joint arthroplasty, and to study the clinical and radiographic outcomes in relation to the approach: volar or dorsal.
Methods:
A total of 22 PIP joint replacements were performed between 2005 and 2010. The mean age was 56 years and the mean follow-up period was 29 months. The implant used in all patients was the Avanta® PIP Soft-Skeletal Implant (Avanta Orthopaedics, San Diego, USA). The dorsal approach was performed in 14 joints, and a volar approach in 8 joints. The preoperative clinical evaluation included a visual analogue scale (VAS) and the range of motion (ROM). The preoperative ROM mean was -15°/60° in both groups. The VAS and the ROM in the last follow-up visit were recorded and compared with preoperative values.
Results:
The postoperative ROM of the dorsal approach group had a mean of -15°/60°, and that of the volar approach was -2°/62°.
Conclusion:
It was found that the volar approach in this series offers the advantages of maintaining the integrity of the extensor mechanism, resulting in a complete restoration of the extension in the range of motion.
