手指PIP関節変形性関節症に対する背側進入によるAVANTA人工指関節置換術の手術成績

抄録

Objective: The surgical results of the AVANTA artificial finger joint replacement by dorsal approach for osteoarthritis of proximal interphalangeal (PIP) joint of the hand was examined.

Methods: The subjects were 13 patients (14 fingers) who underwent surgery from 2014 to 2018 and were observed for a minimum of 10 months. The average age at the time of surgery was 68 years old (48 to 80 years old); 11 of them were women and two of them were males. The number of affected fingers was five middle fingers (two left and three right), seven ring fingers (six left and one right), and two little fingers (two left). We observed a high incidence of left ring fingers. We also operated on multiple fingers on the same hand (one case) and with the ring and middle fingers on the left. The average follow-up period was 23 months (10 to 56 months). Surgery was indicated for patients who had severe pain, severely restricted joint movement, and impaired activities of daily living (ADL). At operation, an arcuate incision on the dorsal side of the PIP joint exposed the extensor tendon longitudinally in addition to the joint. The head of the proximal phalanges were resected with a bone saw, and the middle phalangeal base was resected with Riuel, then reamed under radiographic imaging. After that, AVANTA artificial finger joints were then inserted.

 Postoperative range of motion (ROM) exercise commenced with ‘buddy’ taping to the adjacent finger from the next day after surgery.

Results: Pain disappeared in all cases. According to the Mayo Clinic score, surgical results were good in 10 cases, fair in four cases and poor in no cases. There were no cases with implant breakage or reoperation.

Conclusion: AVANTA artificial finger joint replacement by the dorsal approach is relatively easy to perform and stable results are obtained after surgery. As our follow-up periods were short, we plan a longer follow-up period for future cases.