Skip to main content

Advertisement

SpringerLink
Log in

Radiographic and surgical considerations in arthritis surgery of the hand

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Indications for hand surgeries include unremitting joint pain, deformity and stiffness, often secondary to arthritis. Several surgical options are available, including arthrodesis (fusion) and joint arthroplasty. Classically arthrodesis is performed in situations with poor bone stock and supporting soft tissues. Arthroplasty is reserved for patients and joints in which preservation of function is important and bone stock and soft tissue support are adequate. In this article we will review various techniques for arthrodesis and arthroplasty, their post-surgical imaging appearance, including key findings important to surgeons, and the findings that indicate post-surgical complications. Radiographs are the mainstay for postoperative evaluation and will be the focus of the imaging portions of this review. Advanced imaging modalities will be reviewed when applicable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Johnstone BR, Fitzgerald M, Smith KR, Currie LJ. Cemented versus uncemented surface replacement arthroplasty of the proximal interphalangeal joint with a mean 5-year follow-up. JHS. 2008;33A:726–32.

    Google Scholar 

  2. Chan MK, Chowchuen P, Workman T, Eilenberg S, Schweitzer M, Resnick D. Silicone synovitis: MR imaging in five patients. Skelet Radiol. 1998;27:13–7.

    Article  CAS  Google Scholar 

  3. Sierakowski A, Zweifel C, Sirotakova M, Sauerland S, Elliot D. Joint replacement in 131 painful osteoarthritic and post-traumatic distal interphalangeal joints. J Hand Surg Eur Vol. 2011;37E(4):304–9.

    Google Scholar 

  4. Fowler JR, Baratz ME. Distal interphalangeal joint arthrodesis. J Hand Surg [Am]. 2014;39:126–8.

    Article  Google Scholar 

  5. Burton RI, Margles SW, Lunseth PA. Small-joint arthrodesis in the hand. J Hand Surg [Am]. 1986;11:678–82.

    Article  CAS  Google Scholar 

  6. Kocak E, Carruthers KH. Distal interphalangeal joint arthrodesis with Herbert headless compression screw: outcomes and complications in 64 consecutively treated patients. Hand. 2011;6:56–9.

    Article  PubMed  Google Scholar 

  7. Cox C, Earp BE, Floyd WE, Blazar PE. Arthrodesis of the thumb interphalangeal joint and finger distal interphalangeal joints with a headless compression screw. J Hand Surg [Am]. 2014;39(1):24–8.

    Article  Google Scholar 

  8. Savvidou C, Kutz J. Interphalangeal and thumb metacarpophalangeal arthrodesis with intramedullary implant. Ann Plast Surg. 2013;70:34–7.

    Article  CAS  PubMed  Google Scholar 

  9. Arata J, Ishikawa K, Soeda H, Kitayama T. Arthrodesis of the distal interphalangeal joint using a bioabsorbable rod as an intramedullary nail. Scand J Plast Reconstr Surg Hand Surg. 2003;37:228–31.

    Article  PubMed  Google Scholar 

  10. Mantovani G, Fukushima WY, Cho AB, Aita MA, Lino Jr W, Faria FN. Alternative to the distal interphalangeal joint arthrodesis; lateral approach and plate fixation. JHS. 2008;33A:31–4.

    Google Scholar 

  11. Bales JG, Wall LB, Stern PJ. Long-term results of Swanson silicone arthroplasty for proximal interphalangeal joint osteoarthritis. J Hand Surg [Am]. 2014;39(3):455–61.

    Article  Google Scholar 

  12. Swanson AB, Maupin BK, Gajjar NV, de Groot Swanson G. Flexible implant arthroplasty in the proximal interphalnangeal joint of the hand. JHS. 1985;10A:796–805.

    Google Scholar 

  13. Luther C, Germann G, Sauerbier M. Proximal interphalangeal joint replacement with surface replacement arthroplasty (SR-PIP): functional results and complications. Hand. 2010;5:233–40.

    Article  PubMed  Google Scholar 

  14. Murray P. Surface replacement arthroplasty of the proximal interphalangeal joint. JHS. 2007;32A:899–904.

    Google Scholar 

  15. Daecke W, Kaszap B, Martini AK, Hagena FW, Rieck B, Jung M. A prospective, randomized comparison of 3 types of proximal interphalangeal joint arthroplasty. JHS. 2012;37A:1770–9.

    Google Scholar 

  16. Petscavage J, Ha AS, Chew FS. Arthroplasty of the hand: radiographic outcomes of pyrolytic carbon interphalangeal and metacarpophalangeal joint replacements. AJR. 2011;197:1177–81.

    Article  PubMed  Google Scholar 

  17. Tagil M, Geijer M, Abramo A, Kopylov P. Ten years’ experience with a pyrocarbon prosthesis replacing the proximal interphalangeal joint. A prospective clinical and radiographic follow-up. J Hand Surg Eur Vol. 2014;39(6):587–95.

    Article  CAS  PubMed  Google Scholar 

  18. Reissner L, Schindele S, Hensler S, Marks M, Herren DB. Ten year follow- up pyrocarbon implants for proximal interphalangeal joint replacement. J Hand Surg Eur Vol. 2014;39(6):582–6.

    Article  CAS  PubMed  Google Scholar 

  19. Callaghan JJ, Rosenburg AG, Rubash HE. The adult hip, vol. 2. Philedelphia: Lippincott; 2007. Print.

    Google Scholar 

  20. Heers G, Springorum HR, Baier C, Gotz J, Grifka J, Renkawitz T. Proximal interphalangeal joint replacement with an unconstrained pyrocarbon prosthesis (Ascension): a long-term follow–up. J Hand Surg Eur Vol. 2013;38(6):680–5.

    Article  CAS  PubMed  Google Scholar 

  21. Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SC. Green’s operative hand surgery, vol. 1. 6th ed. Philedelphia: Elsevier; 2011. Print.

    Google Scholar 

  22. Pellegrini Jr VD, Burton RI. Osteoarthritis of the proximal interphalangeal joint of the hand: arthroplasty or fusion? J Hand Surg. 1990;15A:194–209.

    Article  Google Scholar 

  23. Rizzo M. Metacarpophalangeal joint arthritis. JHS. 2011;36A:345–53.

    Google Scholar 

  24. Chung KC, Kotsis SV, Wilgis EFS, Fox DA, Regan M, Kim HM, et al. Outcomes of silicone arthroplasty for rheumatoid metacarpophalangeal joints stratified by fingers. J Hand Surg. 2009;34A:1647–52.

    Article  Google Scholar 

  25. Goldfarb CA, Stern PJ. Metacarpophalangeal joint arthroplasty in rheumatoid arthritis. A long-term assessment. J Bone Joint Surg Am. 2003;85-A(10):1869–78.

    Article  PubMed  Google Scholar 

  26. Harris D, Dias JJ. Five-year results of a new total replacement prosthesis for finger metacarpophalangeal joints. J Hand Surg Eur Vol. 2003;28B(5):432–8.

    Article  Google Scholar 

  27. Simpson-White RW, Chojnowski AJ. Pyrocarbon metacarpophalangeal joint replacement in primary osteoarthritis. J Hand Surg Eur Vol. 2014;39(6)575–81.

  28. Wall LB, Stern PJ. Clinical and radiographic outcomes of metacarpophalangeal joint pyrolytic carbon arthroplasty for osteoarthritis. JHS. 2013;38A:537–43.

    Google Scholar 

  29. Parker WL, Rizzo M, Moran SL, Hormel KB, Bekenbaugh RD. Preliminary results of nonconstrained pyrolytic carbon arthroplasty for metacarpophalangeal joint arthritis. J Hand Surg [Am]. 2007;32(10):1496–505.

    Article  Google Scholar 

  30. Gillis J, Calder K, Williams J. Review of thumb carpometacarpal arthritis classification, treatment and outcomes. Can J Plast Surg. 2011;19:134–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Vermeulen GM, Brink SM, Sluiter J, Elias SG, Hovius SER, Moojen TM. Ligament reconstruction arthroplasty for primary thumb carpometacarpal osteoarthritis (Weilby technique): prospective cohort study. J Hand Surg. 2009;34A:1393–401.

    Article  Google Scholar 

  32. Yao J, Lashgari D. Thumb basal joint: utilizing new technology for the treatment of a common problem. JHT. 2014;27:127–33.

    Google Scholar 

  33. Shah A, Martin 3rd G, Thomas JG. A novel use for suture button suspension: reconstruction of the dorsal ulnar ligament to treat thumb metacarpal dislocation. Case Rep Plast Surg Hand Surg. 2015;2(1):7–11.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Brigham and Women’s Hospital, Department of Radiology, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Violeta Nikac & Barbara N. Weissman

  2. Brigham and Women’s Hospital, Department of Orthopedics, Harvard Medical School, Boston, MA, USA

    Philip Blazar & Brandon Earp

Authors
  1. Violeta Nikac
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip Blazar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brandon Earp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara N. Weissman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Violeta Nikac.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Glossary

Artelon spacer (Artimplant AB, Sweden)

Composed of a biodegradable synthetic material and is placed between the trapezium and metacarpal bone to prevent impingement and to act as a scaffold for autologous tissue regeneration.

Dynamic compressing intramedullary implants (X-fuse)

The implant has an X shape with flexible legs that can be tightened before insertion with a narrow area located at the joint level to protect from axial and rotational loading and to increase bone contact for fusion. Dynamic compressing intramedullary implants (X-Fuse, MMI-USA, Memphis) are commonly used in the DIP joints and come in different sizes with prefixed joint angles (0, 15, 25°).

GraftJacket (LifeCell, USA)

Substance composed of donated cadaver tissue from which the cellular components have been removed while retaining the collagen scaffold.

Permacol (Medtronic, USA)

Surgical implant derived from porcine dermal collagen, where the cells have been removed.

Polyethylene and metal surface replacement arthroplasties

The PIP-SRA (Small bone innovations, New York, NY- formerly avanta) arthroplasty consists of a distal component with an ultra-high molecular weight polyethelene surface on a textured titanium stem with a proximal cobalt chromium alloy component (13). Other products are available that provide different shapes of the articular surfaces with cemented or uncemented stems including options with in-growth or press-fit stems.

The MCP-SRA (Small bone innovations, New York, NY; formerly avanta) arthroplasties consist of a distal component with ultra-high molecular weight polyethylene with a proximal cobalt chromium alloy component with rectangular-shaped and curved stems to maximize stability. Other products are available that are variations with different-shaped articular surfaces and with cemented or uncemented stems including options with bone in-growth or press-fit stems.

Surface replacement arthroplasy (SRA):

Arthroplasties with anatomically designed surfaces that preserve the collateral ligaments and limit bone excision.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nikac, V., Blazar, P., Earp, B. et al. Radiographic and surgical considerations in arthritis surgery of the hand. Skeletal Radiol 46, 591–604 (2017). https://doi.org/10.1007/s00256-017-2591-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-017-2591-z

Keywords

Search

Navigation