title: Revision Proximal Interphalangeal Arthroplasty: An Outcome Analysis of 75 Consecutive Cases.
abstract: OBJECTIVE
  To examine the outcomes and complications associated with revision proximal interphalangeal (PIP) joint arthroplasty.
  
  
  METHODS
  An analysis of 75 consecutive revision PIP joint arthroplasties in 49 patients, performed between 1998 to 2012, was performed. The mean age at the time of surgery was 58 years. Thirty-two patients had a history of prior PIP joint trauma, and 18 patients had rheumatoid arthritis. There were 12 constrained (silicone) implants and 63 nonconstrained implants (34 pyrocarbon and 29 metal-plastic).
  
  
  RESULTS
  Over the 14-year period, 19 (25%) fingers underwent a second revision surgery. Second revision surgeries were performed for infection, instability, flexion contracture, and heterotopic ossification. The 2-, 5-, and 10-year survival rates were 80%, 70%, and 70%, respectively, for patients requiring a second revision for PIP joint arthroplasty. Worse outcomes were seen with postoperative dislocations, pyrocarbon implants, and when bone grafting was required. Two operations were complicated by intraoperative fractures, but neither required stabilization. Sixteen patients undergoing revision surgery experienced a postoperative complication, including 2 infections, 1 postoperative fracture, 3 cases of heterotopic ossification, and 10 PIP joint dislocations. The volar approach and the use of a pyrocarbon implant was associated with increased rates of heterotopic ossification, whereas preoperative instability increased the rates of PIP joint dislocation following revision. At a mean of 5.3 years (range, 2-10 years) follow-up, 98% of patients had good pain relief but decreased PIP joint total arc of motion.
  
  
  CONCLUSIONS
  Proximal interphalangeal joint arthroplasty in the revision setting represents a challenge for surgeons. Revision arthroplasty was associated with a 70% 5-year survival but with a high incidence of complications. Instability was associated with worse outcomes. In this series, silicone and metal-polyethylene implants had lower rates of implant failure and postoperative complications than ones made from pyrocarbon.
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wagner
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
authors.forename: T David
authors.initials: TD
authors.lastname: Luo
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Houdek
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN.
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Kor
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moran
authors.affiliation: Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN. Electronic address: rizzo.marco@mayo.edu.
authors.forename: Marco
authors.initials: M
authors.lastname: Rizzo
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000601:surgery; D001178:Arthroplasty / Q000379:methods; D050806:Arthroplasty, Replacement, Finger / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005383:Finger Injuries / Q000473:pathology / Q000601:surgery; D005384:Finger Joint / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Proximal interphalangeal joint arthroplasty; revision surgery