title: Proximal interphalangeal joint replacement in patients with arthritis of the hand: a meta-analysis.
abstract: We systematically reviewed all the evidence published   in the English language on proximal interphalangeal joint (PIPJ)   replacement, to determine its effectiveness on the function of the   hand and the associated post-operative complications. Original studies were selected if they reported clinical outcome   with a minimum of one year's follow-up. Quality was assessed using   the Cowley systematic review criteria modified for finger-joint   replacements. Of 319 articles identified, only five were adequately   reported according to our quality criteria; there were no randomised   controlled trials. PIPJ replacements had a substantial effect size   on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1)   and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect   on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach   was most successful. Post-operative loosening occurred in 10% (95%   CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon   replacements. Post-operative complications occurred in 27.8% (95%   CI 20 to 37). We conclude that the effectiveness of PIPJ replacement has not   been established. Small observational case studies and short-term   follow-up, together with insufficient reporting of patient data,   functional outcomes and complications, limit the value of current   evidence. We recommend that a defined core set of patients, surgical and   outcome data for this intervention be routinely and systematically   collected within the framework of a joint registry.
authors.affiliation: University of Southampton, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK.
authors.forename: J
authors.initials: J
authors.lastname: Adams
authors.forename: C
authors.initials: C
authors.lastname: Ryall
authors.forename: A
authors.initials: A
authors.lastname: Pandyan
authors.forename: C
authors.initials: C
authors.lastname: Metcalf
authors.forename: M
authors.initials: M
authors.lastname: Stokes
authors.forename: S
authors.initials: S
authors.lastname: Bradley
authors.forename: D J
authors.initials: DJ
authors.lastname: Warwick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000601:surgery*; D050806:Arthroplasty, Replacement, Finger; D005260:Female; D005384:Finger Joint / Q000601:surgery*; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged