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Revision Rate Higher for Patients With Uncemented Surface Replacement Arthroplasties

Although hip and knee arthroplasty (replacement) are quite common now, finger joint replacements - particularly the proximal interphangeal (PIP) joint - are not done as often. This is the joint closest to the tip of the finger. The replacements that have been done vary in how successful they have been.

The authors of this study wanted to compare how the uncemented procedure compared with the cemented procedure in the PIP joint, to see if this could be one of the reasons why the success of the surgery was so varied, particularly among younger patients who need to use their fingers more and for a longer period of time than would older patients. The researchers compared the findings on 18 patients who had a total of 27 PIP joints replaced with the cemented prosthesis (replacement) and 18 patients who had 21 prosthesis with the uncemented technique.

The researchers pointed out that the success of the surgery depends on a combination of factors, not just the cemented versus uncemented issue. These include the implant design, differences between the patients themselves, surgical technique and after surgery care.

When assessing the patients, the researchers assessed the patients' pain with a Visual analog score (VAS) of 0 to 10, with 0 being no pain and 10 being the most severe the patient experienced. The researchers also checked for the patients' range of motion, and x-rays.

After surgery, the patients used a splint and exercises began on the first day after surgery. The strength of the exercises increased according to the patients' ability and healing. The patients were followed for more than two years.

After the surgery, the results were only available for 28 patients, 24 with cemented implants and 19 uncemented implants. The researchers found that the average pain score dropped by 5.5 from before surgery and the range of motion increased by an average of 13 degrees. When looking at pain and range of motion in relation to the type of prosthesis, no differences were found between the cemented and uncemented replacement. When assessing joint failures, there were two failures in the cemented group. Follow-up showed no loosening or failure for several years. In the uncemented group, however, there were 5 joint failures. There were also eight other instances of implants loosening or difficulty with movement over the follow-up period.

In conclusion, the authors wrote that there were no differences in the pain scores before and after surgery between uncemented and cemented replacements but there was a significant difference between the two groups in loosening and failure of the replacements.


Bruce R. Johnstone, MB, BS, et al. Cemented Versus Uncemented Surface Replacement Athroplasty of the Proximal Interphalangeal Joint With a Mean 5-Year Follow-up. In Journal of Hand Surgery June 2008. Vol. 33. No. 5. Pp. 726-733.

07/30/2008

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