AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

A New Frontier: Total Joint Arthroplasty for the Treatment of PIP Joint Arthrosis
Institution where the work was prepared: The Permanente Medical Group, Sacramento, CA, USA
Robert R. Slater, MD, FACS; The Permanente Medical Group
Introduction:
Proximal interphalangeal (PIP) joint arthrosis is a challenging problem for patient and surgeon alike. Previously, the gold standard for its treatment was arthrodesis,
and many methods of performing that procedure have been described. More recently, new implants have been developed that offer an alternative treatment.
Total joint arthroplasty of the PIP joint is now a viable option and is the subject of this report.
Methods:
The Ascension total joint arthroplasty system was used in a series of patients to treat primary osteoarthrosis (OA) of the PIP joint. Indications were painful OA
in fingers with adequate bone stock, adequate surrounding soft tissue quality and good muscle-tendon function. Patients were treated post-operatively according
to protocols developed for this purpose. Follow-up visits included physical and radiographic exams and queries about patient satisfaction.
Results:
To date, the prosthesis has been used in 9 joints (7 patients). All patients were female with an age range of 62-81 years. Concomitant procedures were done
in some instances as indicated. Minimum follow-up was one year in all cases (maximum follow-up to date = 3 years). All patients were very satisfied with the
level of pain relief and improvement of hand function, and they all said they would choose the procedure again and recommend it to others. With one exception,
all joints achieved between 82 and 90 degrees flexion with extensor lags of 0 to 10 degrees. That was a significant improvement vs. pre-op condition.
Pinch and grip strength improved 30% vs. pre-op values, presumably primarily from pain relief.
Discussion:
The Ascension PIP total joint arthroplasty system is made from a graphite core coated with pyrolytic carbon via chemical vapor deposition, resulting in a biologically
inert polymer. It has a proven track record in long-term use in other arenas, such as cardiac valve prostheses. Pyrocarbon has an elastic modulus better
matched to bone compared with alternative joint replacement materials. Use of the device for treating PIP joint arthrosis requires IRB approval; the FDA
classifies it as approved for use under the restrictions of the humanitarian device exemption (HDE) policies. Early results as reported here are encouraging and
are similar to results reported previously by the designing surgeons. The results warrant further study of the use of the device in those patients who meet the
relatively narrow indications.
The Dorsal/Volar Method Improves Reliability in Measuring Wrist Range of Motion: An In Vitro Study of
Reliability and Accuracy of Manual Goniometry
Institution where the work was prepared: Hospital for Special Surgery, New York, NY, USA
Aviva L. Wolff, BS, OTR, CHT; Timothy I. Carter, BA; Brian Pansy, BS; Howard J. Hillstrom, PhD; Sherri I. Backus-Saccoliti, DPT; Mark W. Lenhoff, BS; Scott W. Wolfe, MD;
Hospital for Special Surgery
Background
Despite its ubiquitous use in measuring objective outcomes of hand surgery and therapy, there is limited data concerning accuracy or repeatability of manual
goniometry for wrist motion. The purpose of this study is to establish the accuracy and reliability (inter/intra-rater) of three manual goniometric alignment
techniques°Xulnar, radial and dorsal/volar - in cadaveric upper extremities.
Methods
External fixators were applied to ten cadaveric wrists with intramedullary canulated rods in the radius and third metacarpal for "gold-standard" fluoroscopic
verification of posture. Wrists were positioned at angles of maximum flexion, extension, radial and ulnar deviation for reliability testing and at pre-selected
angles across the range of motion for accuracy testing. At each position, wrist position was measured with a one-degree increment goniometer, and fluoroscopic
angles measured digitally. Manual goniometric measurements were captured by two raters, (hand surgeon/hand therapist) for reliability measurements,
and by a single rater for accuracy. ICC and root mean squared (RMS) values were calculated for all combinations and ANOVA used to test differences between
techniques (alpha