Anatomically Neutral Silicone Small Joint Arthroplasty for Osteoarthritis

PurposeSurgical treatment of osteoarthritis at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints includes arthrodesis and, more recently, arthroplasty. Silicone joint arthroplasty has been shown to relieve pain and restore function in damaged joints. The purpose of this study was to assess outcomes in patients who had MCP or PIP arthroplasty for osteoarthritis using the NeuFlex implant (DePuy, Warsaw, IN), a silicone implant with an anatomically neutral design.MethodsA total of 13 MCP and 16 PIP joint replacements in 19 patients were performed with a mean follow-up period of 4 years (range, 1–8 years). Failed conservative management of osteoarthritis was the indication for surgery in all cases. There were 10 men and 9 women. The average age at the time of surgery was 66 years. Outcomes were assessed by questionnaire evaluation, physical examination, and radiographs.ResultsThe mean flexion arc of motion was 65° and 61°, and the mean extension lag was 3° and 0° in the MCP and PIP groups, respectively. Pain relief was rated excellent or good in 84 percent. The overall patient satisfaction was 90 percent. The Michigan Hand Outcomes Questionnaire (MHQ) score at follow-up was 88 in the MCP group and 87 in the PIP group. There was 1 implant fracture in the PIP group.ConclusionsAt mean 4-year follow-up evaluation, we report high rates of pain relief and patient satisfaction, a low rate of implant fracture, and highly satisfactory range of motion values compared to other implant designs. We show that treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function.Type of study/level of evidenceTherapeutic IV.