Palmar approach in flexible implant arthroplasty of the proximal interphalangeal joint

Joint replacement is an established method in the treatment of destroyed, p ainful, proximal interphalangeal joints. A palmar approach was used in whic h the main collateral ligaments were preserved, allowing immediate active r ehabilitation with enhanced primary lateral stability. Fifty-nine proximal interphalangeal joint silicone arthroplasties in 38 patients with a minimum followup of 12 months were reviewed, Thirty-eight of the 59 joints had imp lantation from a palmar approach and 21 joints from a dorsal approach. The tno groups were well-matched in terms of indication, preoperative range of motion, and patient age. No significant increase in the range of motion was found in either of the patient groups, with an overall average range of mo tion of 51 degrees postoperatively. There was also no significant differenc e in the postoperative stability in the two patient groups. The choice of s urgical approach at the proximal interphalangeal joint level for the silast ic type of implants does not appear to be important. With more sophisticate d types of implants in which the integrity of the collateral ligaments is c rucial, a palmar approach might be beneficial.