Abstract
Introduction
PIPJ replacement has become increasingly popular however, there is very little clinical data available apart from small studies and those from the originators of the prostheses. We present a review of our initial experience with the Acension(c) Pyro-carbon PIP joint.
Results
Data was collected from 62 joints in 39 patients with one patient lost to follow-up. Mean age was 61.6 years. 29 patients were female and 10 male. Mean follow up was 22.3 months (range 11 to 54). 7 patients or 11% needed further surgery. The majority were for stiffness with 3 operations for dislocation or component malposition. The total complication rate was 32%, again the biggest problem was stiffness. 4 joints have subluxed or dislocated, 2 had superficial infections. There was no statistical difference in the rate of complications compared to the operated finger or the pre-operative diagnosis.
Post-operatively patients had a mean fixed flexion deformity of 19° and flexed to 76° (58° arc). However patients undergoing surgery following trauma do not do as well as the other groups with a decrease in ROM of 33°.
Conclusions
Subjectively patients are returning low pain scores and the majority are pleased with the outcome of their surgery. There is however a high rate of complications and re-operations. This is in part due to the complexity of the cases as patients with inflammatory arthritis, following trauma or infection or those who are undergoing revision procedures often have decreased bone stock, erosions and more complex soft tissue balancing resulting in an increase in the complication rate.
We have found the early results to be encouraging and, when successful, better than the short term results for arthrodesis or silastic implants. We intend to continue with the technique but believe patients should be kept under review.
