 |
 Clinical Example: Distal Interphalangeal Joint Arthroplasty
with reversed Ascension carbon implant arthroplasty
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These two cases illustrate the use of the Ascension PIP joint implant
arthroplasty in the DIP joint position. The stem of the distal
component is too wide to fit into the typical distal phalanx, but the
proximal component stem will, and in selected cases, the implant will
fit in this position if it is placed in a reversed proximal-distal
position. These cases illustrate this technique - not as an
endorsement, but as a demonstration of technical feasibility. At one
year, each reconstructed joint was painless and had about 30 degrees
range of motion.
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Click on each image
for a larger picture
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| Distal
interphalangeal erosive osteoarthritis severe enough that the diagnosis
of giant cell or other tumor was suspected. Fortunately, no tumor was encountered at surgery. |
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| Surgical
procedure. |
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| Dorsolateral
eponychial splitting incision. The black debris represents foreign body
pencil lead debris from a childhood injury. |
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| Intraoperative
fluoroscopy. |
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| Broach. |
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| The
trial implant sizer shows the true size of the implant. The final
implant has a radiolucent coating which makes it appear
smaller than it is on Xray. |
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| Final
implant radiographs. |
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| The
implant in place. The approach was similar to the bayonette exposure demonstrated in this
case. |
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| 6 months postop. |
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| Xrays one year out. |
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| Progressive PIP changes remain a problem. |
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Second case.
This patient had previous experience with both DIP fusion and PIP arthroplasty. |
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| Ring finger DIP joint of the opposite hand. |
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| Intraoperative fluoroscopy using the same technique as above. The trial spacers: |
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| The final implant: |
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| Xrays one year out. |
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American
Society
for
Surgery
of the
Hand
assh.org
The Best
Resource
For Your
Hands,
Period.
|
