The first proximal interphalangeal joint (PIPJ) replacements were hinged devices with single-axis motion. Newer implant arthroplasties of the PIPJ have anatomically designed proximal phalangeal and middle phalangeal components. A need to create balanced forces across the joint was the rationale for the semiconstrained PIPJ prosthesis, which uses an anatomic design. These low-profile implants limit bone excision while preserving the integrity of the collateral ligaments. Paramount in the success of this implant is maintaining the integrity of the insertion of the central slip as it inserts on the base of the middle phalanx. The proximal and middle phalanx should be broached such that the largest implant can be press-fit in place. Greater stability is gained with a collateral ligament-preserving implant. Patient selection should include those patients with sufficient soft-tissue integrity. In general, patients with inflammatory disorders, collateral ligament insufficiency, and acute or chronic PIPJ septic arthritis are poor candidates for PIPJ surface replacement arthroplasty.
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Accepted: April 23, 2007
Received: February 6, 2007
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
© 2007 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.