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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Description/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.

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
URI: http://eprints.soton.ac.uk/id/eprint/343371

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