Implant survival, range of motion, and complications of proximal interphalangeal joint arthroplasty have been reported often, but patient-reported outcomes are less frequently described. This study evaluated patients' experiences during the first year after proximal interphalangeal joint arthroplasty, measured with the Michigan Hand Outcomes Questionnaire (MHQ). The primary focus was the reduction of patient-reported pain after proximal interphalangeal joint implant placement and the percentage of patients who considered this reduction clinically relevant, indicated by the minimal clinically important difference (MCID).
Data were collected prospectively; 98 patients completed the MHQ before and at 3 and 12 months after surgery. Our primary outcome was the change in the pain score. An increase of 24 points or more was considered a clinically important difference. Secondary outcomes included changes in MHQ total and subscale scores and MCIDs, range of motion (ROM), patient satisfaction with the outcome of the surgery, and complications.
The pain score improved significantly, from 42 (95% confidence interval, 38–46) at baseline to 65 (95% confidence interval, 60–69) at 12 months after surgery. The MCID was reached by 50% (n = 49) of patients. The ROM did not improve, reoperations occurred in 13% (n = 13) of patients, and swan neck deformities only occurred among surface replacement implants.
Although most patients undergoing arthroplasty for osteoarthritis experienced significantly less pain after surgery, the pain reduction was considered clinically relevant in only 50% (n = 49) of patients. Patients with high MHQ pain scores before surgery are at risk for postoperative pain reduction that will not be clinically relevant. Likewise, the other subscales of the MHQ improved after surgery, but reached a clinically relevant improvement in only 46% (n = 45) to 63% (n = 62) of patients. This knowledge can be used during preoperative consultation to improve shared decision making.
Type of study/level of evidence
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- The routine use of patient reported outcome measures in healthcare settings.BMJ. 2010; 340: c186
- Long-term assessment of Swanson implant arthroplasty in the proximal interphalangeal joint of the hand.J Hand Surg Am. 2004; 29: 785-795
- Silicone proximal interphalangeal joint arthroplasty for primary osteoarthritis using a volar approach.J Hand Surg Am. 2014; 39: 1075-1081
- Prosthetic replacement of the proximal interphalangeal joint.Hand Clin. 2006; 22: 201-206
- A prospective, randomized comparison of 3 types of proximal interphalangeal joint arthroplasty.J Hand Surg Am. 2012; 37: 1770-1779.e1
- Anatomically neutral silicone small joint arthroplasty for osteoarthritis.J Hand Surg Am. 2009; 34: 292-300
- Ten years’ experience with a pyrocarbon prosthesis replacing the proximal interphalangeal joint. A prospective clinical and radiographic follow-up.J Hand Surg Eur Vol. 2014; 39: 587-595
- Pyrocarbon proximal interphalangeal joint arthroplasty: minimum five-year follow-up.J Hand Surg Am. 2015; 40: 2142-2148
- Reliability and validity testing of the Michigan hand outcomes questionnaire.J Hand Surg Am. 1998; 23: 575-587
- Performance of the Michigan hand outcomes questionnaire in hand osteoarthritis.Osteoarthritis Cartilage. 2018; 26: 1627-1635
- Outcomes of pyrolytic carbon arthroplasty for the proximal interphalangeal joint.Plast Reconstr Surg. 2009; 123: 1521-1532
- Outcomes of pyrolytic carbon arthroplasty for the proximal interphalangeal joint at 44 months’ mean follow-up.Plast Reconstr Surg. 2012; 129: 1139-1150
- Conical, radiographic, and patient-reported results of surface replacing proximal interphalangeal joint arthroplasty of the hand.Iowa Orthop J. 2011; 31: 140-144
- Pyrolytic carbon resurfacing arthroplasty for osteoarthritis of the proximal interphalangeal joint of the finger.J Bone Joint Surg Am. 2011; 93: 1417-1425
- What are the minimally important changes of four commonly used patient-reported outcome measures for 36 hand and wrist condition-treatment combinations?..Clin Orthop Relat Res. 2022; 480: 1152-1166
- Test-retest reliability and construct validity of the satisfaction with treatment result questionnaire in patients with hand and wrist conditions: a prospective study.Clin Orthop Relat Res. 2021; 479: 2022-2032
- Radiological assessment of osteo-arthrosis.Ann Rheum Dis. 1957; 16: 494-502
- Why and how to report surgeons’ levels of expertise.J Hand Surg Eur Vol. 2016; 41: 365-366
- A distally based dorsal and triangular tendinous flap for direct access to the proximal interphalangeal joint.Ann Chir Main. 1988; 7: 179-183
- Equipe Zorgbedrijven.(Accessed June 1, 2019.)
- Routine health outcome measurement: development, design, and implementation of the hand and wrist cohort.Plast Reconstr Surg. 2020; 146: 343-354
- What do we know about the reliability and validity of physical examination tests used to examine the upper extremity?.J Hand Surg Am. 1999; 24: 185-193
- GPOWER: A general power analysis program.Behav Res Meth Instrum Comput. 1996; 28: 1-11
- The proximal interphalangeal joint: arthritis and deformity.EFORT Open Rev. 2019; 4: 254-262
- A systematic review of different implants and approaches for proximal interphalangeal joint arthroplasty.Plast Reconstr Surg. 2017; 139: 1139e-1151e
Published online: May 26, 2022
Accepted: March 16, 2022
Received: December 30, 2020
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
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