Prosthetic Arthroplasty of Proximal Interphalangeal Joints forTreatment of Osteoarthritis and Posttraumatic Arthritis: Systematic Review andMeta-Analysis Comparing the Three Ulnar Digits With the IndexFinger

摘要

Background: It is common teaching that treatment of index fingeralone is a relative contraindication for arthroplasty of the proximalinterphalangeal joint (PIPJ). However, limited data exist reporting thedigit-specific complication of PIPJ arthroplasty for the treatment ofosteoarthritis or posttraumatic arthritis. The purpose of this article is toperform a systematic review and meta-analysis of the literature to assesswhether the 3 ulnar digits may bear a similar instability and complicationprofile. Methods: Systematic searches of the MEDLINE, EMBASE, andCochrane computerized literature databases were performed for PIPJ arthroplastyspecifying by digit. We reviewed both descriptive and quantitative data to: (1)report aggregate instability and instability-related complications afternon-index digit PIPJ arthroplasty; and (2) perform statistical testing to assessrelative rates by digit and compared with index digits. Results:Computerized search generated 385 original articles. Five studies reportingdigit-specific instability-related outcomes of silicone, pyrocarbon, or metalsurface arthroplasty on 177 digits were included in the review. Meta-analysisdemonstrated a 29% instability rate for long digits (n = 65), 6% for ring digits(n = 53), and 6% for small digits (n = 17), compared with 33% for index digits(n = 42). There was no difference in the overall deformity, instability, andcomplication rates of long versus index fingers (P = .65).Conclusions: Instability-related deformity and complicationrates of long finger PIPJ arthroplasty may not be different from that of theindex finger. Treatment of the long finger may be a relative contraindication toPIPJ arthroplasty. Future biomechanical and clinical studies are needed.