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.
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.
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.
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
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Published online: November 23, 2009
Accepted: August 17, 2009
Received: January 8, 2009
P.K. and M.T. receive royalties from Ascension Orthopedics.
© 2010 Published by Elsevier Inc.