Reoperative Options in Failed Proximal Interphalangeal and Metacarpophalangeal Joint Arthrodesis and Replacement

  • Marco RizzoEmail author


Revising previous arthroplasties done in either the metacarpophalangeal joint or the ­proximal interphalangeal joint can be technically very difficult. Frequently, the bone stock has been either resorbed or eroded, making potential reimplantation of new joint replacements quite challenging. Furthermore, the soft-tissue envelope is usually severely scarred, and there can be issues with tendon imbalance as well as ligamentous laxity. This combination of bone and soft-tissue factors sometimes precludes the ability to perform revision implant surgery. In these circumstances, arthrodesis can be of benefit; however, care needs to be taken to try and not unduly shorten the digit, which could lead to tendon imbalance. Ultimately, in some cases where there is such significant structural loss of the finger or where the finger has no functional usage, amputation can be considered. Ultimately, the patient needs to understand that the revision surgery is unlikely to yield improved motion but is done in order to try and help preserve hand function while reducing any pain or other symptoms that the patient may be having.


Revision Metacarpophalangeal Proximal Interphalangeal Joint Arthroplasty 


  1. 1.
    Goldfarb CA, Stern PJ. Metacarpophalangeal joint arthroplasty in rheumatoid arthritis. A long-term assessment. J Bone Joint Surg Am. 2003;85-A(10):1869–78.PubMedGoogle Scholar
  2. 2.
    Burgess SD, Kono M, Stern PJ. Results of revision metacarpophalangeal joint surgery in rheumatoid patients following previous silicone arthroplasty. J Hand Surg Am. 2007;32(10):1506–12.PubMedCrossRefGoogle Scholar
  3. 3.
    Wilson YG, Sykes PJ, Niranjan NS. Long-term follow-up of Swanson’s silastic arthroplasty of the metacarpophalangeal joints in rheumatoid arthritis. J Hand Surg Br. 1993;18(1):81–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Parkkila T, et al. Osteolysis after Sutter metacarpophalangeal arthroplasty: a prospective study of 282 implants followed up for 5.7 years. Scand J Plast Reconstr Surg Hand Surg. 2006;40(5):297–301.PubMedCrossRefGoogle Scholar
  5. 5.
    Parker W, et al. Nonrheumatoid metacarpophalangeal joint arthritis. Unconstrained pyrolytic carbon implants: indications, technique, and outcomes. Hand Clin. 2006;22(2):183–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Cook SD, et al. Long-term follow-up of pyrolytic carbon metacarpophalangeal implants. J Bone Joint Surg Am. 1999;81(5):635–48.PubMedGoogle Scholar
  7. 7.
    Swanson AB. Silicone rubber implants for replacement of arthritis or destroyed joints in the hand. Surg Clin North Am. 1968;48(5):1113–27.PubMedGoogle Scholar
  8. 8.
    Linscheid RL, et al. Development of a surface replacement arthroplasty for proximal interphalangeal joints. J Hand Surg Am. 1997;22:286–98.PubMedCrossRefGoogle Scholar
  9. 9.
    Bravo CJ, et al. Pyrolytic carbon proximal interphalangeal joint arthroplasty: results with minimum two-year follow-up evaluation. J Hand Surg Am. 2007;32(1):1–11.PubMedCrossRefGoogle Scholar
  10. 10.
    Takigawa S, et al. Long-term assessment of Swanson implant arthroplasty in the proximal interphalangeal joint of the hand. J Hand Surg Am. 2004;29(5):785–95.PubMedCrossRefGoogle Scholar
  11. 11.
    Jennings CD, Livingstone DP. Surface replacement arthroplasty of the proximal interphalangeal joint using the PIP-SRA implant: results, complications, and revisions. J Hand Surg Am. 2008;33(9):1565 e1–11.CrossRefGoogle Scholar
  12. 12.
    Chamay A. A distally based dorsal and triangular tendinous flap for direct access to the proximal interphalangeal joint. Ann Chir Main. 1988;7(2):179–83.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryMayo Clinic College of MedicineRochesterUSA

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