Proximal interphalangeal joint replacement in patients with arthritis of the hand: a meta-analysis

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 Journal of Bone and Joint Surgery, British Volume, 94-B, (10), 1305 -1312. (doi:10.1302/0301-620X.94B10.29035).


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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.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1302/0301-620X.94B10.29035
ISSNs: 0021-9355 (print)
Subjects: R Medicine > R Medicine (General)
Organisations: Faculty of Health Sciences, Advancing Clinical & Expert Practice
ePrint ID: 343371
Date :
Date Event
September 2012Published
Date Deposited: 03 Oct 2012 15:20
Last Modified: 16 Jun 2017 16:40
Further Information:Google Scholar

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