Use of Cement Advised in Arthroplasty of PIP Joint


FAJARDO, P.R. — Patients undergoing arthroplasty of the proximal interphalangeal joint should opt for the cement, Bruce Johnstone, M.D., advised at the annual meeting of the American Association for Hand Surgery.

In 2000, the Avanta surface replacement proximal interphalangeal (PIP) joint was modified to incorporate a titanium stemmed distal component that allows for press fit cementless fixation, Dr. Johnstone noted.

But ever since the product's modification, observational evidence suggests that loosening and subsiding occurs more frequently when cement is not used with this second-generation device, Dr. Johnstone explained.

In a study involving 49 joint replacements using the cement-optional device, 1 of 27 cemented implants with at least 1 year of follow-up loosened and subsided, and 18 of the 27 have had no loosening or subsiding in up to 6 years of follow-up.

Of 22 cementless implants, 10 have loosened or subsided in up to 3 years of follow-up, reported Dr. Johnstone of Royal Children's Hospital, Melbourne, Australia.

When loosening and subsiding has occurred, it is often with angulation that leads to the stems of the device penetrating the cortical bone.

At first the subsidence is typically asymptomatic. However, as it progresses, pain and stiffness tend to develop, he said.

As a precaution, it is best to use methylmethacrylate bone cement to fix the stems of the cement-optional Avanta PIP surface replacement arthroplasty, he recommended at the meeting.

Those with cemented implants experienced a significant decrease in their pain, with scores on the visual analog scale improving by 5 points or more, Dr. Johnstone said.

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