Proximal Interphalangeal (PIP) Joint Implant Arthroplasty - Extended (Feat. Dr. Boyer)

Video Description

Proximal Interphalangeal (PIP) Joint Implant Arthroplasty Using a Volar Approach

Authors: Boyer MI1, Yee A2
Published: September 7, 2021

Author Information
1: Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
2: Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

Extended Edition (210616.210616)

ABSTRACT
Proximal interphalangeal (PIP) joint arthroplasty can provide pain-free and functional restoration to the mobility and stability of the joint. In cases with less than 30 degrees of deviation in the coronal plane, silicone implant interposition arthroplasty can be used. While a dorsal approach is used most frequently, post-operative immobilization of varying amounts of time are required to allow for healing of the extensor mechanism. Although technically more demanding, the volar approach allows for immediate post-operative rehabilitation. In this case, a 65-year-old patient presented with painful osteoarthritis of the PIP joint of the right index finger, resulting in weakness of pinch and loss of motion. She has had a previous DIP arthrodesis. Plain radiographs revealed coronal deformity without sagittal malalignment, and 10-55 degrees of passive motion. A volar approach was recommended. This video describes the successful reconstruction of the index PIP joint using silicone implant arthroplasty from a volar approach.

KEYWORDS
Proximal interphalangeal joint, hand arthritis, PIP implant arthroplasty, volar approach, silicone implant

POSITION
Supine

INCISION
Combined Bruner and mid-axial incision along the PIP joint of the right index finger.

TABLE OF CONTENTS (Extended)
00:05 Introduction
00:25 Pre-operative Imaging (X-ray)
00:35 Orientation
00:45 Pre-operative Examination of the PIP Joint
01:07 Placement of Incision
01:33 Incision
02:03 Exposure
02:13 Identifying Neurovascular Bundle of the Medial Aspect of Index Finger
02:24 Dividing Grayson Ligament and Following the Neurovascular Bundle Distally
03:07 Elevating the Neurovascular Bundle Medially
03:16 Exposure and Identifying the Flexor Sheath
04:25 Visualization of Flexor Sheath with A2 and A4 Pulley
04:35 Creating a Flexor Sheath Window to Expose the Flexor Tendons
04:55 Identifying the Flexor Tendons and Volar Plate
05:17 Creating a Volar Plate Flap Away From Its Proximal Insertion to Visualize the PIP Joint
07:55 Gentle Hyperextension of the PIP Joint to Visualize the Distal and Proximal Phalanx
08:05 Limited Resection of Distal and Proximal Phalanx to Create Parallel Heads
11:00 Visualization of Parallel Distal and Proximal Phalanx
11:33 Illustration of Limited Resection of Distal and Proximal Phalanx
12:02 Creating a Canal in the Distal Phalanx
12:56 Intraoperative Imaging
13:37 Developing a Canal in the Proximal Phalanx with Intraoperative Imaging
13:58 Refining Distal and Proximal Canals with Broach with Using Intraoperative Imaging
14:38 Insertion of Trial Implant to Assess Alignment and Stability
15:04 Final Bony Resection and Irrigation of Distal and Proximal Canals
16:01 Overview of the Anatomical Structures of the PIP joint
16:49 Insertion of Silicone Implant into the PIP Joint
17:21 Reconstructing the Volar Plate
18:47 Reconstructing the Flexor Sheath
19:27 Final Intraoperative Imaging
19:37 6-Weeks and 9-Weeks Post-Operative Outcome
20:01 Credits