Lee Squitieri1, Kevin C Chung. 1. Ann Arbor, Mich. From the University of Michigan Medical School and the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.
Abstract
BACKGROUND: Posttraumatic conditions of the proximal interphalangeal and metacarpophalangeal joints require arthroplasty or fusion for pain control and functional improvement. Arthroplasty is increasingly becoming a preferred option for maintaining joint motion. However, a formal systematic review comparing the three currently available techniques-vascularized toe joint transfer, silicone, and PyroCarbon arthroplasty-has not been performed to critically evaluate outcomes and complication rates for these three options. METHODS: The authors used a formal systematic review of all available world literature (English and non-English). Data collection included active arc of motion as the primary outcome, and complication rates. RESULTS: Five hundred twenty articles were identified, reviewed, and screened through multiple inclusion/exclusion criteria. The mean proximal interphalangeal active arcs of motion for vascularized toe joint, silicone, and PyroCarbon were 37 +/- 9 degrees, 44 +/- 11 degrees, and 43 +/- 11 degrees, respectively. The mean metacarpophalangeal active arcs of motion for vascularized toe joint and silicone were 34 +/- 10 degrees and 47 +/- 16 degrees, respectively. Major complication rates requiring joint revision procedures for vascularized toe joint, silicone, and PyroCarbon were 29, 18, and 33 percent, respectively. CONCLUSIONS: Vascularized toe joint transfer has a worse active arc of motion and a higher complication rate when compared with silicone implant arthroplasty for both proximal interphalangeal and metacarpophalangeal joints. Early data suggest that PyroCarbon implants may be associated with higher rates of major complications. Given the lack of improvement in outcomes for posttraumatic finger joint reconstruction over the past 40 years, research efforts should focus on future development of novel arthroplasty devices.
BACKGROUND:Posttraumatic conditions of the proximal interphalangeal and metacarpophalangeal joints require arthroplasty or fusion for pain control and functional improvement. Arthroplasty is increasingly becoming a preferred option for maintaining joint motion. However, a formal systematic review comparing the three currently available techniques-vascularized toe joint transfer, silicone, and PyroCarbon arthroplasty-has not been performed to critically evaluate outcomes and complication rates for these three options. METHODS: The authors used a formal systematic review of all available world literature (English and non-English). Data collection included active arc of motion as the primary outcome, and complication rates. RESULTS: Five hundred twenty articles were identified, reviewed, and screened through multiple inclusion/exclusion criteria. The mean proximal interphalangeal active arcs of motion for vascularized toe joint, silicone, and PyroCarbon were 37 +/- 9 degrees, 44 +/- 11 degrees, and 43 +/- 11 degrees, respectively. The mean metacarpophalangeal active arcs of motion for vascularized toe joint and silicone were 34 +/- 10 degrees and 47 +/- 16 degrees, respectively. Major complication rates requiring joint revision procedures for vascularized toe joint, silicone, and PyroCarbon were 29, 18, and 33 percent, respectively. CONCLUSIONS: Vascularized toe joint transfer has a worse active arc of motion and a higher complication rate when compared with silicone implant arthroplasty for both proximal interphalangeal and metacarpophalangeal joints. Early data suggest that PyroCarbon implants may be associated with higher rates of major complications. Given the lack of improvement in outcomes for posttraumatic finger joint reconstruction over the past 40 years, research efforts should focus on future development of novel arthroplasty devices.
Authors: Kevin C Chung; Sandra V Kotsis; E F Shaw Wilgis; David A Fox; Marian Regan; H Myra Kim; Frank D Burke Journal: J Hand Surg Am Date: 2009-11 Impact factor: 2.230