Proximal interphalangeal joint arthroplasty using self-locking type surface replacement implant for symptomatic osteoarthritis: Extended dorsal central splitting approach and intermediate-term outcome

Abstract

Background: This retrospective study introduced wide exposure and radical osteophytectomy by employing the extended dorsal central splitting approach (EDCSA) to mitigate complications associated with surface implant arthroplasty for osteoarthritis of the proximal interphalangeal (PIP) joint using a self-locking type of implant.

Methods: In total, 171 fingers of 113 patients underwent cementless surface non-constrained PIP implantation using the EDCSA. The surgical approach involved larger implant placement, optional procedures, and complex collateral ligament repair following wide exposure and thorough shaving of the osteophytes and periarticular bone. Pre- and postoperative outcomes; range of motion; Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scores; subjective pain scores; radiographic findings; and patient satisfaction were assessed.

Results: The active range of motion of the PIP joint improved from -18°/58° to -15°/84° (extension/flexion), and remaining stiffness (arc < 40°) was observed in 21 PIP joints (12%) at a mean follow-up of 4.8 years. Patients reported significantly reduced pain and improved Q-DASH scores, with 92% overall patient satisfaction. Radical osteophytectomy effectively prevented recurrence and heterotopic ossification. Complications in the operated fingers occurred in 24.0% of cases, with a reoperation rate of 8.8%, primarily due to soft tissue-related issues. No implant-related symptomatic complications were identified, except for 1 case of dislocation and 1 of mild implant loosening with infection.

Conclusion: Self-locking surface replacement implants offer stable fixation without failure in the intermediate term. The EDCSA demonstrated excellent results and advantages, leading to easy identification of each joint structure to facilitate radical osteophytectomy.

Keywords: Arthroplasty; Dorsal approach; Finger; Proximal Interphalangeal Joint; Surface replacement implant.