Purpose
To prospectively register and report the hand function and occupational performance
of patients with proximal interphalangeal joint–pyrocarbon arthroplasty, using both
objective tests and subjective outcome instruments.
Methods
From 2004 to 2008, 53 joints in 43 patients were reconstructed with a proximal interphalangeal
joint–pyrocarbon prosthesis. The patients underwent a rehabilitation program allowing
early motion with an extension stop to limit hyperextension. Range of motion, grip
strength, and pain (Visual Analog Scale [VAS]) were recorded and the subjective outcome
was evaluated using Canadian Occupational Performance Measure (COPM) and Disabilities
of the Arm, Shoulder, and Hand score.
Results
Seven patients were reoperated on (2 infections, 2 arthrodesis, 2 tenolysis, and 1
hyperextension). Pain (VAS) at rest improved from 3.1 cm preoperatively to 0.4 cm
(p < .001) and pain (VAS) at activity from 6.2 to 2.0 cm (p < .001) at the latest
follow-up (mean, 24 months; minimum, 12 months [± 2 weeks]). Disabilities of the Arm,
Shoulder, and Hand score improved from a median of 39 to 29 (p = .026). The COPM subjective
measurement of occupational performance, improved from a median of 4.6 preoperatively
to 5.9 (p = .013) at the latest follow-up, and the COPM, measurement of satisfaction
improved from a median of 3.8 to 5.9 (p = .002). Range of motion and grip strength
were unchanged.
Conclusions
All patients reported decreased pain, and although we found no improvement in range
of motion and grip strength, one third of patients reported a clinically significant
improvement in occupational performance and satisfaction. A total of 13% of the joints
required a secondary surgical procedure.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: November 23, 2009
Accepted:
August 17,
2009
Received:
January 8,
2009
Footnotes
P.K. and M.T. receive royalties from Ascension Orthopedics.
Identification
Copyright
© 2010 Published by Elsevier Inc.
