Srnec, Jason J.

* There are limited motion-sparing salvage options for patients with pancarpal wrist arthritis. Total wrist arthroplasty is one option that has long been used in an attempt to preserve motion while relieving pain and wrist dysfunction; however, enthusiasm for the procedure has been tempered by high rates of complications. * In an attempt to minimize or eliminate these complications, recent implants have been redesigned with a more semiconstrained arc of motion and ellipsoidal articulation. Furthermore, the distal component has undergone many different modifications to improve bone growth into the implant. * Short-term small series have shown promising improvements in terms of the rate of complications as compared with previous-generation designs.

We retrospectively reviewed and compared the outcomes and complications associated with 81 single digit and 168 multi-digit proximal interphalangeal joint arthroplasties performed from 1998 to 2012 in 136 patients. Clinical outcomes were assessed with an average follow-up of 5.3 years for single digit and 5.9 years for multi-digit proximal interphalangeal joint arthroplasty. Comparing single versus multi-digit proximal interphalangeal joint arthroplasty, the reoperation-free survival was 67% and 68% at 5 years and 56% and 67% at 10 years, respectively. Furthermore, in comparison of single versus multi-digit proximal interphalangeal joint arthroplasty, the revision-free survival was 80% and 86% at 5 years and 80% and 85% at 10 years, respectively. Given the similar, or even slightly improved, rates of complications, reoperation, and revision surgery, proximal interphalangeal joint arthroplasty performed on multi-digits results in no worse outcomes compared with single digit proximal interphalangeal joint arthroplasty. Level of evidence: IV