Long-term results of Swanson silicone arthroplasty for proximal interphalangeal joint osteoarthritis

Abstract

Purpose: To review the long-term outcome of the Swanson silicone arthroplasty in the osteoarthritic proximal interphalangeal (PIP) joint at a single institution.

Methods: We identified 51 patients who had undergone PIP joint Swanson silicone arthroplasty for osteoarthritis and included in the study only those 22 patients (38 joints) who responded and could follow up. These patients returned for follow-up evaluation at an average of 10 years (range, 2-24 y). Subjective outcomes were assessed using the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire, visual analog pain scale, and Likert questionnaire scores. Clinical and radiographic objective data were collected by measuring range of motion and coronal plane deformation and assessing final radiographs.

Results: Silicone arthroplasty at the PIP joint consistently provided pain relief in patients who returned for follow-up. The average Quick-Disabilities of the Arm, Shoulder, and Hand score was 17 and the average pain visual analog scale score was 0.4. The Likert questionnaire revealed that on average, patients agreed or strongly agreed that they would have surgery again, would recommend surgery to another patient, and were satisfied at an average of 10 years after surgery. Patients had neutral responses when they rated appearance, functional improvement, and range of motion. Objectively, range of motion (flexion arc of 50°) did not significantly change from the preoperative flexion arc (55°). Radiographically, 31 implants had deformation, including 21 with implant fracture. There were 3 revisions for symptomatic implant fractures and 1 implant was removed for infection. There was no correlation between radiographs and satisfaction.

Conclusions: Despite unchanged range of motion and considerable radiographic implant deformation or fracture, patients obtained consistent pain relief and satisfaction. With an implant survivorship of 90% at average of 10 years postoperatively, silicone implant arthroplasty remains our treatment of choice for the symptomatic osteoarthritic PIP joint.

Type of study/level of evidence: Therapeutic IV.

Keywords: Osteoarthritis; proximal interphalangeal joint; silicone arthroplasty.