近端指间关节关节炎
Patients › Hand
Osteoarthritis and inflammatory arthritis of the PIP joint — non-operative and surgical options.
您的感受
您的手指中间关节(即近端指间关节)可能会感到疼痛。这种疼痛通常源于磨损性关节炎或既往损伤造成的损害。只有当疼痛严重到影响您完成日常活动时,您的外科医生才可能建议进行此手术。您可能会注意到,在使用手部后或早晨醒来时,疼痛会加重。
简单的动作可能会变得非常困难。您可能难以伸手到背后扣上胸罩或把衬衫塞进裤子里。关节可能会感到僵硬,导致您无法完全弯曲或伸直手指。在某些情况下,关节的活动度可能不如以前,并且这种活动范围可能会随时间推移而恶化。如果您患有类风湿关节炎,早期使用特定药物治疗可以帮助改善您的症状。
尽管疾病过程复杂,但您可以预期术后疼痛得到缓解,功能得到改善。许多患者发现,关节表面置换术能提供良好的缓解效果,且并发症较少。然而,您应该知道,随着时间的推移,您手指的活动度可能会略有下降。如果您的手指存在屈曲挛缩(即手指卡在弯曲状态),在手术前或手术后进行系列石膏固定可能有助于纠正这一问题。您的外科医生将根据您的具体症状和关节状况评估此手术是否适合您。
实际发生了什么
在您的手指中,覆盖在骨端的光滑涂层(称为软骨)会随时间磨损。这种磨损性关节炎就像失去了缓冲作用的减震器。随着软骨变薄,骨头相互摩擦,导致疼痛和僵硬。您可能会发现,在进行日常活动时,您的活动范围变小,因为关节不再平滑地滑动。
问题不仅仅局限于骨骼。肌腱(像连接肌肉和骨骼的纤维绳索)在疾病早期就会发生变化。这些肌腱跨越多个关节,因此一个区域的变化会影响整个手指的运动方式。这种相互依赖性意味着,当手指的一部分发生变化时,其他部分难以跟上。随着时间的推移,这些肌腱和相关结构的变化会导致您看到的畸形。
您的外科医生看到,这一过程是由力量在您的手部中的传递方式驱动的。患有此病的女性通常手部力量显著降低,大多数类型的力量平均下降30%。压缩剪切力也会随着时间的推移损害关节,导致进一步磨损。当关节囊(围绕关节的套状结构)和韧带失去稳定性时,骨头会发生移位。这种移位造成了疼痛和功能受限,促使您来看外科医生。
我们能采取的措施
您的治疗通常从自我管理和物理治疗开始。如果您手指僵硬,对于部分关节炎患者,系列石膏固定是矫正屈曲挛缩的有效方法。这一过程有助于您在无需手术的情况下恢复活动能力。您的外科医生还可能推荐锻炼以保持关节灵活。在考虑更侵入性的治疗之前,您应给予这些非手术选项充分的机会。
如果简单护理效果不佳,您的外科医生可能会讨论药物治疗。虽然证据未详细说明针对该关节的具体药物名称或注射类型,但证实缓解疼痛是主要目标。对于部分患者,重点在于管理症状以维持功能。如果关节炎导致致残性功能障碍性疼痛,您的外科医生可能会在特殊情况下考虑特定的手术选项,如 TACTYS 假体。然而,对于许多人来说,重点是在管理不适的同时保持关节的良好功能。
当保守治疗达到极限时,手术成为一种可靠的选择。在适当的临床背景下,近端指间关节植入物成形术是治疗症状性关节炎的良好且可靠的选择。该手术可提供可靠、长期的疼痛缓解并维持功能。大多数患者在术后中位时间为 8 周后重返工作岗位。虽然关节感觉可能会改善,但您应被告知,使用某些假体时,关节活动度可能会随时间推移而下降。您的外科医生将帮助您判断这是否是您特定手指的正确治疗步骤。
何时就诊
如果您因磨损性关节炎或创伤性关节炎导致的持续性疼痛在休息后未见改善,请寻求专科医生评估。如果您出现手指无力、不稳定或卡顿,请及时就医。如果症状影响您的睡眠或工作,请联系您的医生。如果您注意到病情突然加重,也应寻求建议。请注意,关节活动度可能会随时间推移而下降。如果您患有糖尿病,在考虑手术前请与您的外科医生讨论并发症风险较高的问题。
Evidence & references
Overview
- Surface replacement arthroplasty of the proximal interphalangeal joint using a volar approach can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint arthroplasty [2].
- There has been an increased use of primary proximal interphalangeal joint arthroplasty utilization for patients with osteoarthritis, whereas revision proximal interphalangeal joint arthroplasty has decreased [3].
- Treatment of metacarpophalangeal and proximal interphalangeal joint osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Patients returned to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [5].
- Serial casting is an effective method to correct flexion contractures in proximal interphalangeal joints in selected patients with arthritis [6].
- Minimizing postoperative complications after metacarpophalangeal and proximal interphalangeal joint arthroplasty is one avenue to decrease health care costs [7].
- Proximal interphalangeal joint implant arthroplasty is a good and reliable option for symptomatic proximal interphalangeal joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Minimum two years of follow-up evaluation of the self-locking finger joint implant proximal interphalangeal joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [11].
- Silicone arthroplasty for osteoarthritis of the proximal interphalangeal joint remains a good option for pain relief [13].
- Pyrolytic carbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of proximal interphalangeal joint arthritis [16].
Anatomy & Pathophysiology
- Women with hand osteoarthritis exhibited significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types [21].
- People with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with controls [32].
- The internal structure and material properties of the phalanges play a significant role in both the magnitude and distribution of stresses in the MCP joint during common tasks [24].
- Interdependency of joints is a primary feature of finger function [39].
- The function of a muscle with respect to a certain joint cannot be inferred from the position of the muscle with respect to that one joint alone due to tendons bridging multiple joints [39].
- Changes occurring in the tendons and related structures are the most important factor in the development of finger deformities, especially in early stages [27].
- Detailed understanding of the functional anatomy and related pathologic features of the trapeziometacarpal joint complex provides the basis for treatment of acquired afflictions at the base of the human thumb [31].
- Compressive shear forces can lead over time to trapeziometacarpal joint osteoarthritis [33].
- In most degrees of freedom of metacarpal movement relative to the trapezium, the dorsoradial ligament (DRL) is relatively more important than the deep anterior oblique ligament (dAOL) in providing stability to the TMC joint [36].
- Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes [22].
- Type I and III wrists had radiographic progression and ultimately underwent deformation [20].
- Most of the outcome measures associated with hand OA or RA are related to body structures and body functions or activity limitations and participation restrictions [30].
Classification
- Surface replacement arthroplasty of the proximal interphalangeal joint using a volar approach can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint arthroplasty [2].
- Primary proximal interphalangeal joint arthroplasty utilization has increased for patients with osteoarthritis, whereas revision utilization has decreased [3].
- Treatment of metacarpophalangeal and proximal interphalangeal joint osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Patients returned to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [5].
- Serial casting is an effective method to correct flexion contractures in proximal interphalangeal joints in selected patients with arthritis [6].
- Minimizing postoperative complications after metacarpophalangeal and proximal interphalangeal joint arthroplasty is one avenue to decrease health care costs [7].
- The TACTYS prosthesis should be proposed exceptionally if the proximal interphalangeal joint arthritis causes invalidating functional pain [8].
- Proximal interphalangeal joint implant arthroplasty is a good and reliable option for symptomatic proximal interphalangeal joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Radiological osteoarthritis after a mallet finger fracture is similar to the natural degenerative process in the distal interphalangeal joint and is accompanied by a decrease in range of motion of the distal interphalangeal joint, which does not clinically affect patient-reported outcome measures [12].
- Pyrolytic carbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of proximal interphalangeal joint arthritis [16].
- Cortical breaks were commonly visualized in metacarpophalangeal and proximal interphalangeal joints with high-resolution peripheral quantitative CT and microCT [17].
- Expert consensus can be reached to identify putative risk factors for interphalangeal joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [18].
- The revision rate for the LPM prosthesis was higher than in published series for other proximal interphalangeal joint implants, warranting close surveillance of all patients with this prosthesis currently in situ [43].
- Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the proximal interphalangeal joint [45].
Clinical Presentation
- PIP joint arthroplasty may be a relative contraindication for treatment of the long finger [2].
- Patients with PIP joint arthritis causing invalidating functional pain should be considered for arthroplasty [8].
- PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief [13].
- Surface replacement arthroplasty of the PIP joint using a volar approach can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Surface replacement arthroplasty of the PIP joint using a volar approach has the tendency to deteriorate in range of motion with longer follow-up [15].
- Pyrolytic carbon hemiarthroplasty for PIP joint arthritis results in good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion [19].
- Patients should be advised that PIPJ range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [9].
- Minimum two-year follow-up evaluation of the Self Locking Finger Joint (SLFJ) implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [11].
- Autologous rib perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure [14].
- Serial casting is an effective method to correct flexion contractures in PIP joints in selected patients with arthritis [6].
- Cortical breaks were commonly visualized in MCP and PIP joints with high-resolution peripheral quantitative CT and microCT [17].
- Expert consensus can be reached to identify putative risk factors for IP joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [18].
- Treatment modalities for PIP joint arthritis are currently limited, and the disease process involves a complex interplay of biochemical, metabolic, and genetic factors rather than simple mechanical stress [40].
- Early diagnosis of rheumatoid arthritis is important, and referral to a rheumatologist followed by treatment with disease-modifying antirheumatic agents has been shown to improve outcomes [35].
Investigations
- The volar approach to proximal interphalangeal joint surface replacement arthroplasty can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint arthroplasty [2].
- There has been an increased use of primary proximal interphalangeal joint implant arthroplasty utilization for patients with osteoarthritis, whereas revision utilization has decreased [3].
- Treatment of metacarpophalangeal and proximal interphalangeal joint osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Patients returned to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [5].
- Serial casting is an effective method to correct flexion contractures in proximal interphalangeal joints in selected patients with arthritis [6].
- Proximal interphalangeal joint implant arthroplasty should be proposed exceptionally if the joint arthritis causes invalidating functional pain [8].
- Patients should be advised that proximal interphalangeal joint range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [9].
- Proximal interphalangeal joint implant arthroplasty is a good and reliable option for symptomatic proximal interphalangeal joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Radiological osteoarthritis after a mallet finger fracture is similar to the natural degenerative process in the distal interphalangeal joint and is accompanied by a decrease in range of motion of the distal interphalangeal joint, which does not clinically affect patient-reported outcome measures [12].
- Silicone arthroplasty for osteoarthritis of the proximal interphalangeal joint remains a good option for pain relief [13].
- Perichondrium transplants restored injured proximal interphalangeal and metacarpophalangeal joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure [14].
- Proximal interphalangeal joint range of motion after surface replacement arthroplasty through a volar approach has the tendency to deteriorate with a longer follow-up [15].
- Cortical breaks were commonly visualized in metacarpophalangeal and proximal interphalangeal joints with high-resolution peripheral quantitative CT and microCT [17].
- Expert consensus can be reached to identify putative risk factors for interphalangeal joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [18].
- Pyrolytic carbon prosthesis replacement of the proximal interphalangeal joint reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion [19].
- Type I and III wrists had radiographic progression and ultimately underwent deformation [20].
- All described techniques for proximal interphalangeal joint arthrodesis can achieve the goal of fusing an osteoarthritic joint [47].
- In patients with established hand osteoarthritis, clinical involvement of the thumb base joint is associated with a higher clinical burden, whereas radiological involvement of the thumb base joint is associated with older age and more structural abnormalities [49].
Treatment
- Surface replacement arthroplasty of the proximal interphalangeal joint using a volar approach can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [1].
- Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint arthroplasty [2].
- There has been an increased use of primary proximal interphalangeal joint arthroplasty utilization for patients with osteoarthritis, whereas revision proximal interphalangeal joint arthroplasty has decreased [3].
- Treatment of metacarpophalangeal and proximal interphalangeal joint osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [4].
- Patients returned to work after a median of 8 weeks following proximal interphalangeal joint arthroplasty [5].
- Serial casting is an effective method to correct flexion contractures in proximal interphalangeal joints in selected patients with arthritis [6].
- Minimizing postoperative complications after metacarpophalangeal and proximal interphalangeal joint arthroplasty is one avenue to decrease health care costs [7].
- The TACTYS prosthesis should be proposed exceptionally if the proximal interphalangeal joint arthritis causes invalidating functional pain [8].
- Patients should be advised that proximal interphalangeal joint range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [9].
- Proximal interphalangeal joint implant arthroplasty is a good and reliable option for symptomatic proximal interphalangeal joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [10].
- Minimum two years of follow-up evaluation of the Self Locking Finger Joint implant proximal interphalangeal joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [11].
- Silicone arthroplasty for osteoarthritis of the proximal interphalangeal joint remains a good option for pain relief [13].
- Proximal interphalangeal joint range of motion after surface replacement arthroplasty through a volar approach has the tendency to deteriorate with a longer follow-up [15].
- Pyrolytic carbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of proximal interphalangeal joint arthritis [16].
- The combination of distal interphalangeal joint arthrodesis and proximal interphalangeal joint Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility [41].
Complications
- Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [2].
- Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs [7].
- Patients should be advised that PIPJ range of motion deteriorates over time [9].
- Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in DIP and thumb IP joint arthrodeses [44].
Recovery
- Patients returned to work after a median of 8 weeks following PIP arthroplasty [5].
- Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs [7].
- Patients should be advised that PIPJ ROM deteriorates over time [9].
- The minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [11].
- Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure [14].
- PIP ROM after SRA through a volar approach has the tendency to deteriorate with a longer follow-up [15].
- The study reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion [19].
Key Evidence
- [L4] The volar approach to PIP SRA can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis. [1] (10.1016/j.jhsa.2011.03.003)
- [L1] Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. [2] (10.1177/1558944718791186)
- [L4] The data demonstrate an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased. [3] (10.1177/1558944719837009)
- [L4] Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function. [4] (10.1016/j.jhsa.2008.11.005)
- [L3] Patients returned to work after a median of 8 weeks following PIP arthroplasty. [5] (10.1177/15589447221141485)
- [L4] SC is an effective method to correct flexion contractures in PIP joints in selected patients with arthritis. [6] (10.1016/j.jht.2015.11.005)
- [L3] Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs. [7] (10.1016/j.jhsa.2019.11.002)
- [L4] It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain. [8] (10.1177/15589447211030962)
- [L4] Patients should be advised that PIPJ ROM deteriorates over time. [9] (10.1016/j.jhsa.2023.11.007)
- [L4] PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. [10] (10.1177/17531934241265837)
- [L4] The minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion. [11] (10.1177/1558944717726136)
- [L4] Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. [12] (10.1016/j.jhsa.2023.03.027)
- [L4] Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. [13] (10.1177/1558944718769427)
- [L4] Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. [14] (10.1186/s12891-020-03310-5)
- [L4] PIP ROM after SRA through a volar approach has the tendency to deteriorate with a longer follow-up. [15] (10.1177/1558944718787332)
- [L4] Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis. [16] (10.1016/j.jhsa.2014.12.016)
- [L4] Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and microCT. [17] (10.1186/s12891-016-1148-y)
- [L4] Expert consensus can be reached to identify putative risk factors for IP joint OA, though the number identified was low and often required multiple Delphi rounds. [18] (10.1177/1753193419865872)
- [L4] The study reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion. [19] (10.1177/1753193413479527)
- [L2] Type I and III wrists had radiographic progression and ultimately underwent deformation. [20] (10.1016/j.jhsa.2009.01.016)
- [L3] Women with hand osteoarthritis exhibited significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types. [21] (10.1016/j.jht.2024.02.005)
- [L5] Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes. [22] (10.5435/jaaos-d-17-00374)
- [L5] The internal structure and material properties of the phalanges were found to play a significant role in both the magnitude and distribution of stresses. [24] (10.1007/s11552-012-9430-4)
- [L4] The most important factor in the development of finger deformities is the changes occurring in the tendons and related structures, especially in early stages. [27] (10.2106/00004623-195739030-00006)
- [L2] Most of the outcome measures associated with hand OA or RA are related to body structures and body functions or activity limitations and participation restrictions. [30] (10.1016/j.jht.2019.12.015)
- [L5] Detailed understanding of the functional anatomy and related pathologic features of the trapeziometacarpal joint complex provides the basis for treatment of acquired afflictions at the base of the human thumb and a model for the more general study of idiopathic osteoarthritis. [31] (10.1097/01.blo.0000176968.28247.5c)
- [L3] This study demonstrated that people with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with the controls, and that with instruction on joint protection techniques, participants made significant changes in the amount of movement used to perform tasks, which supports a proof of principle of joint protection. [32] (10.1016/j.jht.2020.10.010)
- [L5] The resulting compressive shear forces can lead over time to trapeziometacarpal joint osteoarthritis. [33] (10.1016/j.jhsa.2010.10.029)
- [L5] Early diagnosis of rheumatoid arthritis is important, and referral to a rheumatologist followed by treatment with disease-modifying antirheumatic agents has been shown to improve outcomes. [35] (10.1016/j.jhsa.2011.01.036)
- [L5] In most degrees of freedom of metacarpal movement relative to the trapezium, the DRL is relatively more important than the dAOL in providing stability to the TMC joint. [36] (10.1016/j.jhsa.2006.12.002)
- [L5] The paper concludes that interdependency of joints is a primary feature of finger function, and that the function of a muscle with respect to a certain joint cannot be inferred from the position of the muscle with respect to that one joint alone due to tendons bridging multiple joints. [39] (10.2106/00004623-196345080-00007)
- [L5] Treatment modalities for proximal interphalangeal joint arthritis are currently limited, and the disease process involves a complex interplay of biochemical, metabolic, and genetic factors rather than simple mechanical stress. [40] (10.1016/j.jhsa.2010.09.002)
- [L4] The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility. [41] (10.1177/17531934231215790)
- [L4] The revision rate for the LPM prosthesis was higher than in published series for other PIP joint implants, with close surveillance of all patients with this prosthesis currently in situ recommended. [43] (10.1177/1753193407087864)
- [L3] Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in these DIP/thumb IP joint arthrodeses. [44] (10.1186/s12891-024-07361-w)
- [L4] Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the PIP joint. [45] (10.1016/j.jhsa.2014.11.015)
- [L1] All described techniques can achieve the goal of fusing an osteoarthritic joint. [47] (10.1530/eor-21-0102)
- [L3] In patients with established hand OA clinical involvement of the TBJ is associated with a higher clinical burden whereas radiological involvement of the TBJ is associated with older age and more structural abnormalities. [49] (10.1016/j.jht.2014.01.006)
References
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