Proximal interphalangeal joint replacement in patients with arthritis of the hand: A meta-analysis

Adams J, Ryall C, Pandyan A, et al (Univ of Southampton, UK) J Bone Joint Surg Br 94-B:1305-1312, 2012^§

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).

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