Proximal interphalangeal joint replacement in patients with arthritis of the hand: a meta-analysis
Proximal interphalangeal joint replacement in patients with arthritis of the hand: a meta-analysis
We systematically reviewed all the evidence published in the English language on proximal interphalangeal joint (PIPJ) replacement, to determine its effectiveness on the function of the hand and the associated post-operative complications.
Original studies were selected if they reported clinical outcome with a minimum of one year’s follow-up. Quality was assessed using the Cowley systematic review criteria modified for finger-joint replacements. Of 319 articles identified, only five were adequately reported according to our quality criteria; there were no randomised controlled trials. PIPJ replacements had a substantial effect size on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1) and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach was most successful. Post-operative loosening occurred in 10% (95% CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon replacements. Post-operative complications occurred in 27.8% (95% CI 20 to 37).
We conclude that the effectiveness of PIPJ replacement has not been established. Small observational case studies and short-term follow-up, together with insufficient reporting of patient data, functional outcomes and complications, limit the value of current evidence.
We recommend that a defined core set of patients, surgical and outcome data for this intervention be routinely and systematically collected within the framework of a joint registry.
1305 -1312
Adams, J.
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Ryall, C.
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Pandyan, A.
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Metcalf, Cheryl
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Stokes, M.
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Bradley, S.
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Warwick, David J.
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September 2012
Adams, J.
6e38b8bb-9467-4585-86e4-14062b02bcba
Ryall, C.
1d050e52-3791-4fe2-bdbf-e2040b42617f
Pandyan, A.
3c730fee-f68d-40ff-b4f5-ca8f6f9a4811
Metcalf, Cheryl
09a47264-8bd5-43bd-a93e-177992c22c72
Stokes, M.
71730503-70ce-4e67-b7ea-a3e54579717f
Bradley, S.
74f9e46e-c14a-4da6-82e0-5140ecdb3939
Warwick, David J.
d23cacce-41eb-42bd-b8cc-da6a3b837a9f
Adams, J., Ryall, C., Pandyan, A., Metcalf, Cheryl, Stokes, M., Bradley, S. and Warwick, David J.
(2012)
Proximal interphalangeal joint replacement in patients with arthritis of the hand: a meta-analysis.
The Journal of Bone and Joint Surgery, 94-B (10), .
(doi:10.1302/0301-620X.94B10.29035).
Abstract
We systematically reviewed all the evidence published in the English language on proximal interphalangeal joint (PIPJ) replacement, to determine its effectiveness on the function of the hand and the associated post-operative complications.
Original studies were selected if they reported clinical outcome with a minimum of one year’s follow-up. Quality was assessed using the Cowley systematic review criteria modified for finger-joint replacements. Of 319 articles identified, only five were adequately reported according to our quality criteria; there were no randomised controlled trials. PIPJ replacements had a substantial effect size on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1) and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach was most successful. Post-operative loosening occurred in 10% (95% CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon replacements. Post-operative complications occurred in 27.8% (95% CI 20 to 37).
We conclude that the effectiveness of PIPJ replacement has not been established. Small observational case studies and short-term follow-up, together with insufficient reporting of patient data, functional outcomes and complications, limit the value of current evidence.
We recommend that a defined core set of patients, surgical and outcome data for this intervention be routinely and systematically collected within the framework of a joint registry.
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Published date: September 2012
Organisations:
Faculty of Health Sciences, Advancing Clinical & Expert Practice
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Local EPrints ID: 343371
URI: http://eprints.soton.ac.uk/id/eprint/343371
ISSN: 0021-9355
PURE UUID: 7fddd740-05eb-4586-8af1-aa4dca516ff3
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Date deposited: 03 Oct 2012 15:20
Last modified: 15 Mar 2024 03:20
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Author:
C. Ryall
Author:
A. Pandyan
Author:
S. Bradley
Author:
David J. Warwick
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