FLEXIBLE IMPLANT RESECTION ARTHROPLASTY OF THE PROXIMAL INTERPHALANGEAL JOINT IN PATIENTS WITH SYSTEMIC INFLAMMATORY ARTHRITIS

Forty proximal interphalangeal joint silicone elastomer flexible impla nt arthroplasties in 19 patients with systemic inflammatory arthritis were reviewed. The follow-up period averaged 94 months. Before surgery , the average are of motion was 26 degrees for the 20 digits with bout onniere deformities and 23 degrees for the 16 digits with swan-neck de formities. Eight digits had moderate (grade 2) pain, and four digits h ad severe (grade 3) pain. After surgery, the deformity was completely corrected in six digits. Digits with a preoperative boutonniere deform ity (20 digits) achieved the same (26 degrees) are of motion after sur gery, whereas those with a preoperative swan-neck deformity (16 digits ) actually lost 18 degrees. Six digits had moderate pain and one digit had severe pain at the final follow-up evaluation. Thirteen digits (7 patients) with a boutonniere deformity before surgery and a concurren t or previous silastic metacarpophalangeal arthroplasty had significan tly better results than those without. Overall, there were 12 good, 18 fair, and 10 poor results. Based on this study, flexible silicone imp lant arthroplasty has a limited role in the treatment of proximal inte rphalangeal joints affected by systemic inflammatory arthritis. When p erforming the arthroplasty, attention should be directed first toward correction of the deformity at the metacarpophalangeal joint.