Review Question - QID 211391

This older patient with end-stage arthritis of a non-border PIPJ without stated angular or rotational deformity is a perfect candidate for PIPJ arthroplasty. Of the possible implants and surgical approaches that could be utilized, silicone implants placed through a volar approach have comparatively been shown to result in the best range of motion with the lowest rate of revision.

PIPJ arthritis is present in nearly 17% of women and 13% of men and often presents with symptoms including flexion contracture, decrease motion, swelling, and pain. The radial digits are often treated with fusion due to issues with stability, but non-border digits may be better suited for arthroplasty. Pain relief is reported in 98% of patients who undergo silicone arthroplasty and the complication rate is relatively low. The dorsal approach is the historic gold standard and may be technically more straightforward. Surface implants (metal-on-plastic) as well as a silicone implants are available. However, more favorable outcomes have recently been reported with the volar approach and with the use of silicone implants.

Yamamoto et al (2017) performed a systematic review evaluating the various implants and approaches used for PIPJ arthroplasty. The authors found that, as compared to the surface implant with a dorsal approach, the silicone implant placed through a volar approach was associated with significantly less extensor lag, better net gain in arc of motion, better overall post-operative motion, and a lower revision rate (6% vs 18%). They concluded that silicone implant via volar approach was associated with the best outcomes for PIPJ arthroplasty.

Yamamoto et al. (2018) comprehensively review exposure and implant designs for PIPJ arthroplasty. They showed that the volar approach resulted in the best range of motion, with the least extension lag, and lowest compilation rates. The surface implant had the highest rate of surgical revisions. The authors underscored the importance for continued improvement of implant design.

Incorrect answers:
Answer 1: The volar approach has been shown to be superior to the dorsal approach in terms of less extensor lag, improved range of motion, and less complications.
Answer 3: The revision rate of silicone implants placed through a volar approach was 33% that of a surface implant placed through a dorsal approach.
Answer 4: The silicone implant was superior to the other implant types in terms of range of motion and revision rate.
Answer 5: The volar approach and silicone implant have been shown to be superior.