Instructional course lecture| Volume 32, ISSUE 6, P909-913, July 2007

The Dorsal Approach to Silicone Implant Arthroplasty of the Proximal Interphalangeal Joint

  • Kyle D. Bickel
    Corresponding author: Kyle D. Bickel, MD, The Hand Center of San Francisco, 1700 California St, Ste 450, San Francisco, CA 94109.
    The Hand Center of San Francisco and Division of Plastic Surgery, UCSF School of Medicine, San Francisco, CA.
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      Silicone implant arthroplasty (SIA) has been an effective alternative in the treatment of arthritic conditions of the proximal interphalangeal (PIP) joints since its introduction into surgical practice in the early 1960s. Patients with post-traumatic, degenerative, and rheumatoid arthritis all may be candidates for PIP joint SIA. The indications for SIA of the PIP joint include pain, limited joint mobility, and angular deformity of the joint with underlying articular destruction. Contraindications include ankylosis of the joint due to bony or soft-tissue restrictions, infection, inadequate soft-tissue support for coverage, absence of flexor and/or extensor tendon function, and considerable periarticular bone loss in the proximal and middle phalanges. Proximal interphalangeal joint SIA can be accomplished by dorsal, volar, or midaxial approaches. The dorsal approach has the advantages of relative technical ease, excellent visibility of the articular surfaces for preparation of the implant canals, access to the extensor mechanism for correction of central slip abnormalities, and preservation of the collateral ligaments. The surgical technique is outlined and includes handling of the extensor mechanism and central slip attachment, mobilization of the collateral ligaments, joint surface resection, preparation of the bony canals, implant sizing, implant insertion, and repair of the soft tissues. Pearls and pitfalls of the technique are outlined. Early postoperative mobilization with hand therapy is essential but must include protection of the repaired extensor apparatus. Complications include bony changes, implant failure, recurrent angular deviation or swan-neck deformity, particulate synovitis, and rarely, infection. Complications related to implant failure are most often managed with implant replacement or arthrodesis; those related to poor mobility, angular deformity and tendon imbalance, pain, or infection are managed by arthrodesis. Although SIA of the PIP joint has a relatively high degree of success when measured both subjectively and objectively, careful patient selection is important for achieving desirable results.

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        • Niebauer J.J.
        • Landry R.M.
        Dacron-silicone prosthesis for the metacarpophalangeal and interphalangeal joints.
        Hand. 1971; 3: 55-61
        • Swanson A.B.
        • Maupin B.K.
        • Gajjar N.V.
        • Swanson G.D.
        Flexible implant arthroplasty in the proximal interphalangeal joint of the hand.
        J Hand Surg. 1985; 10A: 796-805
        • Peimer C.A.
        • Medige J.
        • Eckert B.S.
        • Wright J.R.
        • Howard C.S.
        Reactive synovitis after silicone arthroplasty.
        J Hand Surg. 1986; 11A: 624-638
        • Foliart D.E.
        Swanson silicone finger joint implants: a review of the literature regarding long-term complications.
        J Hand Surg. 1995; 20A: 445-449
        • Shin A.Y.
        • Amadio P.C.
        Stiff finger joints.
        in: Green’s Operative Hand Surgery. 5th ed. Elsevier Churchill Livingstone, Philadelphia2005: 317-460
        • Linscheid R.L.
        Implant arthroplasty of the hand: retrospective and prospective considerations.
        J Hand Surg. 2000; 25A: 796-816
        • Swanson A.B.
        Implant resection arthroplasty of the proximal interphalangeal joint.
        Orthop Clin North Am. 1973; 4: 1007-1029
        • Iselin F.
        • Conti E.
        Long-term results of proximal interphalangeal joint resection arthroplasties with a silicone implant.
        J Hand Surg. 1995; 20A: S95-S97
        • Hage J.J.
        • Yoe E.P.D.
        • Zevering J.P.
        • deGroot P.J.M.
        Proximal interphalangeal joint silicone arthroplasty for posttraumatic arthritis.
        J Hand Surg. 1999; 24A: 73-77
        • Takigawa S.
        • Meletiou S.
        • Sauerbier M.
        • Cooney W.P.
        Long-term assessment of Swanson implant arthroplasty in the proximal interphalangeal joint of the hand.
        J Hand Surg. 2004; 29A: 785-795
        • Adamson G.J.
        • Gellman H.
        • Brumfield R.H.
        • Kuschner S.H.
        • Lawler J.W.
        Flexible implant resection arthroplasty of the proximal interphalangeal joint in patients with systemic inflammatory arthritis.
        J Hand Surg. 1994; 19A: 378-384