Background. Traditional teaching recommends against arthroplasty in the index finger, due to concerns over failure with pinch stress, and prefers arthrodesis is for its stability. We aim to allay these fears and present the results of our series of index finger silastic PIPJ arthroplasties. Methods: Between 2007 & 2018 48 silastic index finger PIPJ arthroplasties were undertaken in 37 patients at our Hand Unit. All were performed under local anaesthetic ring block. Eleven patients underwent PIPJ arthroplasty in both Index fingers. Thirty-five women and two men made up the cohort with a mean age of 69 years. A retrospective analysis of all patients has been undertaken to determine the clinical results including patient satisfaction, grip and pinch strength and reoperation rates. Mean follow up was 5.1 years. Results. Six index fingers developed ulnar deviation greater than 10 degrees and there were five reoperations (10.2%). There was an excellent arc of movement of mean 44 degrees with high patient satisfaction and functional scores (mean VAS pain score 1.1, Quickdash 34, PEM 44). 90% of patients would undergo the procedure again and no patient would prefer a fusion. Conclusions: Silastic Interposition arthroplasty of the PIPJ of the Index finger is a durable procedure with excellent clinical outcomes. Our large study refutes the established technique of arthrodesis for Index finger OA, with low incidence of ulnar deviation and excellent patient satisfaction

Background. Bouchard -arthrose is often familial and affect predominantly females. It starts as acute inflammation of the soft tissue and with time may progress to severe deformity and limitation of movement. In the early phases one of the most commen operation in the management is the synovialectomy. In late stages with severe destruction and deformity of the joint arthrodesis can be carried out. However, arthrodesis may lead to severe loss of function. One of the most commonly and world wide used prothesis to maintain movement is the Swanson –spacer. Material and Methods. 20 Swanson-implants in 14 patients (12 female,2 male) were evaluated subjectively and objectively using PIJA-score (Interphalangeal-joint –score) and Dash –score. The follow period was 4.6 years (range 1-11 years). Results. The IPJA-score ranged 8-14 points (median 11.8) and the median Dash- score was 28 points. Improvement of pain was oberserved in 90% of the cases. Flexion more than 30° in 85% and full extention in 75%. Ulnar deviation was noted in 7 patients (35%), mostly of the index finger. Fracture of the prothesis occurred only in 1 case. No loosening was observed radiologically. Discussion. Swansin prothesis is good alternative to arthrodesis and be restricted only in cases where the musculotendinous structures are intact. In cases where the index finger is affected, arthrodesis is preferred

Objective. We explanted NeuFlex metacarpophalangeal (MP) joint prostheses to identify common features, such as position of fracture, and thus better understand the reasons for implant failure. Methods. Explanted NeuFlex MP joint prostheses were retrieved as part of an-ongoing implant retrieval programme. Following revision MP joint surgery the implants were cleaned and sent for assessment. Ethical advice was sought but not required. The explants were photographed. The position of fracture, if any, was noted. Patient demographics were recorded. Results. Thirty NeuFlex MP explants were available. Seven (23%) were not fractured. Eleven explants (37%) had fractured at the hinge; nine (30%) had fractured at the junction of the distal stem and hinge; and three (10%) had fractured at both the hinge and distal stem. NeuFlex MP joint explants ranged in size from 0 to 40. Smaller sizes were retrieved from smaller fingers; larger implants came from the middle and index fingers. The age at revision ranged from 43 to 81 (median 58) years. Time in vivo ranged from 6 to 120 (median 58.5) months. All but two implants were obtained from rheumatoid joints, the remainder had osteoarthritis. Discolouration of some explants had occurred; other explants appeared to show no colour change. Conclusions. This is the first report of the position of fracture of NeuFlex explants. It is also the largest report of silicone arthroplasty explants. The majority (77%) had fractured. Nine (30%) NeuFlex explants had fractured at the junction of the distal stem and hinge; the typical position seen with Swanson and Sutter/Avanta MP joint explants. Eleven (37%) fractured across the hinge; this has not previously been reported although has been seen in in vitro testing. The hinge is thinner than the hinge-stem junction so may be at risk of more rapid failure, however the median time in vivo for hinge fractures was 63 months as opposed to 54 months for fractures at the distal stem. Intriguingly, 3 (10%) NeuFlex explants suffered fractures both at the hinge and at the junction of the distal stem and hinge which has also never been reported previously. Fracture at the junction of the distal stem and hinge shows the importance of subluxing forces in rheumatoid MP joints and therefore suggests these need to be mitigated as much as possible. Fracture across the hinge could indicate this as a position which could be increased in thickness, to increase the time taken to fracture, although there may be a concomitant increase in stiffness of the implant. With improved designs, patients might suffer fewer or later failures. The latest Norwegian Arthroplasty Registry report shows that revision MP joint arthroplasties accounted for 42% of all MP joint replacement operations in 2015. Therefore, this is an important area where opportunities exist to reduce revision rates

Introduction. Various methods to manage medial tibial defects in primary total knee arthroplasty (TKA) have been described. According to Vail TP, metal augmentation is usually indicated for defect depth of >10 mm of the medial tibial plateau. The outcomes of metal augmentation have been described as excellent. Nevertheless, we believe that it is mandatory to preserve as much of the bone as possible for future revision surgeries. Therefore, we performed autologous impaction bone grafting even for large bone defects (defect depth of ≥10 mm) in primary TKA. The objectives of this study are to describe our bone grafting technique in detail and to assess the radiological outcomes of the grafted bone. Methods. Between 2003 and 2011, 26 TKAs with autologous impaction bone grafting for ≥10 mm medial tibial defects were performed. The preoperative diagnoses were osteoarthritis in 17 knees, rheumatoid arthritis in 2 knees, osteonecrosis of the medial tibial condyle in 6 knees, and Charcot's joint in 1 knee. The average mediolateral width and depth of the medial tibial defects, measured after the horizontal osteotomy of the tibial articular surface, were 17.8 mm (range, 10–25 mm) and 12.0 mm (range, 10–23 mm), respectively. The average patient age at surgery was 73.2 years (range, 56–85 years). The patients were followed up for an average of 55 months (range 27–109 months). Bone grafting technique: Multiple drill holes (white arrow) were made on the floor of the defect (A) and a morselized cancellous bone was impacted using the grip end of a metal hammer (white asterisk) and firm manual pressure to fill the defect. Thus, the firm impaction prevented bone cement from entering the space between the graft and the tibial host bed. An assistant's index finger (black asterisk) was used as a bank (B). The tibial component was fixed on the grafted bone (white asterisk) with bone cement (C). Internal fixation devices were not required, and stem extension was used in only Charcot's joint (defect depth=23 mm). Aftertreatment was the same as that for the usual TKAs without bone defects. Results. In terms of clinical outcomes, no patient showed disturbances in walking ability at final follow-up. The average knee flexion angle was 114° (range, 95°–130°). The grafted bone was kept at the grafted area on the radiograms throughout the follow-up period. No absorption or collapse of the grafted bone was observed on the radiograms at the final follow-up. Usually, the grafted bone showed osteosclerotic changes around 2–3 months after TKA. Then, the osteosclerosis became weakened and the bony trabeculae could be detected in the grafted area. Finally, the grafted bone completely incorporated into the host bone in all knees with evidence of bony trabeculae crossing the interface by up to 1 year after surgery. The margin of the grafted area resembled bony cortex in 19 TKAs (73.1%). Conclusions. Our technique is easy, economic, and reproducible. It is an acceptable alternative to metal augmentation for large medial tibial defects in primary TKA