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Silicone and Pyrocarbon Artificial Finger Joints

Silicone and Pyrocarbon Artificial Finger Joints Hindawi Applied Bionics and Biomechanics Volume 2021, Article ID 5534796, 12 pages https://doi.org/10.1155/2021/5534796 Review Article 1 1 2 2 3 F. A. Alnaimat , H. A. Owida, A. Al Sharah, M. Alhaj, and Mohammad Hassan Medical Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan Computer Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan Civil Engineering, Faculty of Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan Correspondence should be addressed to F. A. Alnaimat; f.alnaimat@ammanu.edu.jo Received 10 February 2021; Revised 23 May 2021; Accepted 27 May 2021; Published 4 June 2021 Academic Editor: Juan Carlos Prados-Frutos Copyright © 2021 F. A. Alnaimat et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Artificial finger joint design has been developed through different stages through the past. PIP (proximal interphalangeal) and MCP (metacarpophalangeal) artificial finger joints have come to replace the amputation and arthrodesis options; although, these artificial joints are still facing challenges related to reactive tissues, reduced range of motion, and flexion and extension deficits. Swanson silicone artificial finger joints are still common due to the physician’s preferability of silicone with the dorsal approach during operation. Nevertheless, other artificial finger joints such as the pyrocarbon implant arthroplasty have also drawn the interests of practitioners. Artificial finger joint has been classified under three major categories which are constrained, unconstrained, and linked design. There are also challenges such as concerns of infections and articular cartilage necrosis associated with attempted retention of vascularity. In addition, one of the main challenges facing the silicone artificial finger joints is the fracture occurring at the distal stem with the hinge. The aim of this paper is to review the different artificial finger joints in one paper as there are few old review papers about them. Further studies need to be done to develop the design and materials of the pyrocarbon and silicone implants to increase the range of motion associated with them and the fatigue life of the silicone implants. was attributed to a lack of understanding of the mechanics 1. Introduction of small joints and the use of ineffective interpositional mate- Orthopedic surgeons treat patients with rheumatoid and rials [7, 13]. Similarly, researchers note that earlier proce- osteoarthritic hand deformities from time to time. These dures were prone to various complications, including the deformities are distal to the wrist in the proximal interpha- lack of functional motion, loose implants, recurrent joint deformity, component wear, and component fractures, langeal (PIP) and metacarpophalangeal (MCP) joint [1–7]. The PIP joint links the first and second phalanges of the fin- which led to revision surgeries [14]. Most practitioners dur- ger [8]. The MCP, on the other hand, is a condylar, ball, and ing this time are also reported to have preferred arthrodesis socket joint that has a concave-shaped proximal phalanx sur- or amputation [15]. The major complications associated with face and convex-shaped metacarpal anterior [9]. Arthroplas- early PIP and MCP joint treatment in artificial finger joint tic surgery became the standard approach to the treatment of approaches have been overcome through more sophisticated these deformities in the 70s and 80s. Prior to this time, prac- techniques, improved understanding of the joint’s anatomy, titioners supported nonoperative interventions for arthritic and better prosthetic compounds, but modern treatments hand deformities, arguing that if surgical intervention trans- still report varying degrees of success among patients during formed into the standard intervention for proximal joints, postoperative follow-ups. The aim of this article is to review such as the elbow and the shoulder, it would prevent the the different artificial finger joints in one paper as there are gravity-induced deformities of the hand [10–12]. However, few old review papers about them. Review papers about arti- it is important to note that early small joint arthroplasty ficial finger joints are not very numerous and most of them was characterized by poor implant design, an aspect that are evaluating specific finger joint instead of reviewing all 2 Applied Bionics and Biomechanics Liebolt’s footsteps, Caroll and Taber sought to find out if finger joints, their materials, and the failures associated with them. resection could be carried out, but the latter study did not combine soft tissue interposition with long-term postopera- tive digital traction in patients with ankylosed PIP joint 2. Resection/Interposition Arthroplasty [15]. Until this time, as the researchers report, studies had As noted earlier, severe arthritic conditions of the PIP joint not attempted to replace joint arthrodesis in the flexed posi- have been a recurrent problem among patients. The most tion of function [15]. To be considered for treatment, a common treatment approach to this ailment before 1914 patient had to exhibit ankyloses in a position of great defor- mity, had to have perfectly functioning tendons that produce was arthrodesis [1]. Arthrodesis of the distal interphalangeal (DIP) joints has a wide history as with a different range of motion in the middle joint, and be motivated to regain mobility [15]. Caroll and Taber reported that 83 percent of techniques including screw or plate fixation, crossed Kirsch- ner wires (K-wires), and external fixation, as shown in patients had notable improvement, but the process required Figure 1 [16–18]. Bunnell, who led the advocacy of this ther- closely supervised rehabilitation. As knowledge on digital joint replacement grew, apy, felt that patients with an ankylosed and malpositioned joint fared well after arthrodesis [12]. However, following researchers worked towards total replacement. In 1959, soldier’s devastating injuries, including deformed MCP and Brannon and Klein achieved this milestone by applying total PIP joints, the demand for improved therapy was high, replacement in 14 soldiers on active duty [23]. The approach prompting researchers to look for alternative approaches. taken by the researchers included a metal-hinged type of prosthesis, which the researchers used as a replacement for Usually, the therapy using arthrodesis will cause osteolysis failure of the surrounding bone as happened previously, lim- damaged joint [23]. The objective was to restore the function iting finger joint motion, infection, pain, and breakage [5, 13, of a destroyed part of a joint partially. However, the proce- 19]. Particularly, researchers sought to improve the func- dure required patients’ nerves, blood supply, and tendons tional range of finger motion among individuals with post- to be intact; moreover, the individuals had to be motivated. Some notable complications had to be overcome, including traumatic degenerative changes in the MCP and PIP joints [1]. According to Berger, some evidence exists of a number loose screws and sunken prostheses [23]. The researchers of researchers’ attempts to probe resection arthroplasty with reported that out of the 12 soldiers, 10 regained a painless various soft tissue interposition techniques [1]. motion within a functional range; moreover, the hand’s cos- In the 1940s, the calls for improved therapy heightened metic appearance was also improved [23]. However, later follow-ups on these patients reduced the efficacy of the treat- due to the injuries suffered during the Second World War [1, 7]. Particularly, Adkinson and Chung report about the ment, with the results showing implant loosening and frac- introduction of biologically inert Vitallium caps as a replace- tures [7]. Brannon and Klein’s treatment was modified two years later in 1961 by Flat, who sought to improve the rota- ment of the PIP and MCP joints [7]. The approach taken by researchers in this new form of therapy was modelled on tional stability of the hand [24]. With PIP joints, the study outlined three prerequisites, namely, joint ankyloses at dys- arthroplasty techniques in the lower extremities [20]. Vital- lium cups were favored because they were not only inert functional positions, significant joint damage, and persistent but also nonreactive [9]. Moreover, the approach was also swan-neck deformity. With MCP joints, on the other hand, a part from severe damage, as was the case with PIP joints, the attributed to increased motion in the connected joints, but the level of stability was low [9]. It is important to note that other prerequisites for the procedure were persistent ulnar drift and palmar joint dislocation [24]. In both PIP and researchers had previously experimented with Vitallium, cobalt-chromium alloy cups in hip arthroplasty between MCP joints, prosthetic replacement required sufficient mus- 1937 and 1939 [21]. Ineffective earlier approaches to MCP cle power for joint control [24]. However, as was the case with Brannon and Klein’s approach, patient follow-ups in and PIP joint therapy, including replacement with Vitallium cups and arthrodesis, paved the way for modern surface Flatt’s study also revealed some complications, including phalangeal fracture, boutonniere deformity, and poor or total replacement arthroplasty. At the beginning of the 50s, researchers began to look for lack of voluntary control [24]. Total digital joint replace- alternatives to Vitallium cups. Among these attempts were ments were initially faced with several complications that reduced the efficacy of the studies. Liebolt’s recommendations following successful procedures on soldiers injured during the Second World War [22]. Lie- MCP joint resection arthroplasty was first performed at the beginning of the 60s. Fowler is credited with pioneering bolt’s treatment was split into two phases. In the first phase, the process involved a capsulectomy, a procedure that saw research into this area, but other researchers, including Tup- surgeons divide collateral ligaments as well. In the event, per and Vainio, soon followed with a similar approach [25, 26]. Berger reports that the techniques proposed by these articular cartilage had been destroyed, and the surgeon could resect either the distal or the proximal surface of the joint researchers were notable contributions to the medical field’s [22]. In the second phase, the patients need to have postoper- attempt s to reduce pain among patients with severely degen- ative treatment by the physician in which it consists of daily erated MCP joints [1]. Nonetheless, the approaches were passive motion for three days and then active and passive associated with joint instability, and they are mostly motion four times daily done by the patient [22]. The objec- conducted in salvage situations. Modern practice of small tive was for the patient to develop between 30 degrees and 70 joint arthroplasty features several approaches, which will be degrees postoperative range of motion. In 1954, following in explored further below. Applied Bionics and Biomechanics 3 (a) (b) (c) Figure 1: Arthrodesis of finger joint such as (a) Kirschner wires (K-wires), (b) external fixation, and (c) screw fixation. 3. Silicone Implant Arthroplasty a one-piece heat-vulcanized implant could increasingly resist wear and tear more than either hand-molded or hand-carved When synthetic materials emerged as viable materials in implants [30]. More progress was made in the 80s through prosthetic surgery, researchers sought to experiment with continued experimentation. them in resection arthroplasty. The application of these Researchers in the 80s sought to enhance the flexion materials to the restoration of unstable or stifffingers was capabilities of the Swanson implants. Particularly, while particularly sought since finger joints presented one of the some researchers added metal grommets at the stem hub of most difficult areas for reconstructive surgery. Swanson is the interface of the Swanson implants to halt bone erosion, inarguably the pioneer researcher who ushered in the mod- as shown in Figure 2 [35], others sought the same approach, ern era of small joint arthroplasty [7]. Particularly, Swanson’s but their intent was to prevent fracturing of implants [36]. In revolutionary idea involved the silicone spacer [27–31]. In the first study [35], the researchers reported that patients this application, the researcher designed stems of the con- exhibited increased motion and a more functional arc; more- strained Swanson implant to operate as a piston within the over, the level of pain relief was also notable [35]. However, joint [32]. Deployment of silicone rubber for implants as a the researchers observed a high rate of complications among patients who underwent implant reconstruction to correct replacement for damaged joints had been suggested following Swanson’s previous experience regarding the rheumatoid swan-neck deformities [35]. In the second study, development of an intramedullary-stemmed silicone rubber on the other hand, no particulate synovitis and infection were implant, which had been designed to protect the long bone reported; moreover, the researchers observed favorable bone following amputation in the lower extremity [30]. Previous remodeling, with the experiment group showing better results concerning improved bone preservation at the meta- researchers had also affirmed the efficacy of silicone rubber as a unique implant material within the family of silicones physeal and midshaft levels [36]. However, the researchers [33, 34]. The material combined organic and inorganic ele- cautioned that the procedure required proper surgical staging ments, meaning that by fusing silicone and oxygen atoms and optimal preoperative and postoperative techniques [36]. to which organic groups were attached, one could merge In a recent study, researchers reported that the additional use of grommets in the MP joint arthroplasty was attributed to a the inertness of quartz with the fabrication character of plas- tics. Silicone implants were preferred because of their stabil- slight reduction in reactive osteolysis as the components ity, slow rate of deterioration, and nonadhesiveness [30]. acted by cushioning the spacers from breaking; moreover, Moreover, Swanson noted that these compounds had not the grommets were also noted to reduce pain [37]. Applica- only good flexion but also damped force; however, their tion of grommets has also been tested in other joints, includ- ing the wrist [38–41]. application could only be termed optimal if the operation found a way to contain a reported fragility, which increased Overall, the application of silicone implants in research, the compound susceptibility to tear. To overcome these dis- with or without grommets, has been successful in not only advantages, Swanson focused on designing the implant cor- PIP and MCP joints but also other joints, such as the wrist; rectly, with the aim of improving the implant flexural however, the problem of implant fracture persists in these studies. This fracture of the silicone artificial joint could start durability. Results from machine experiments revealed that 4 Applied Bionics and Biomechanics Figure 2: Swanson finger implant with metal grommets. Figure 3: Fatigue fracture of Swanson finger implant at the junction of hinge and stem. with small cut (initial cracks) caused by bone spurs from the bones in the finger or during the insertion the implant reaction to the implant and debris from the degenerating sil- icone. The NeuFlex, as shown in Figure 4, is another silicone could face some damages [42]. Another cause of damage is that the silicone artificial finger joint flexes at the stem implant for MCP and PIP Finger Joints which is made from more than the hinge part of the implant [42–44]. Most of silicone. The NeuFlex metacarpophalangeal joint was tested the Swanson artificial finger joint fractures happened at in vitro using finger simulator, and there was imminent the junction of the distal stem and the hinge, as shown in fracture of the prosthesis across the pivot of the central hinge section [64]. Figure 3 [45–48]. Silicone synovitis is not that popular with the Swanson finger joint in comparison with the other PIP joint implant arthroplasty features various patient silicone implants [49]. and finger characteristics. One common approach is the sili- One problem with silicone implants regards inflamma- cone with volar approach, with which various researchers tory reactions. Some studies have reported increased inflam- have experimented [5, 65–69]. The objectives of existing studies vary from one study to another. In one study, matory reactions attributed to the debris from small joint implants that essentially incite the symptomatic reactions, researchers sought to assess the clinical and radiographic causing pain [50–52]. After successful silicone rubber outcomes on the short-term concerning PIP joint implants implants, some patients have been reported to revisit hospi- that had been conducted using a volar approach [65]. In a tals because of swellings and discomfort [51]. In one study, related study, researchers sought to find out whether PIP joint arthroplasty through a volar approach preserved the Peimer et al. used a sample comprising such patients. The study group encompassed various types of silicone arthro- patient’s extensor apparatus that is necessary if early rehabil- plasty, including lunate, scaphoid, scapholunate, wrist, fin- itation was to be achieved [67]. Proubasta et al. [65] com- ger, trapezium, and ulnar head [51]. The patients had an prised Avanta silicone implants, as shown in Figure 5, established erosive osteolysis, which was ascertained through which had been deployed as a replacement of the PIP joints of 26 patients. To be included in the study, patients had to X-ray films; similarly, the study reported that progressive damage continued with time after initial surgery and implan- have not only failed to respond to conservative treatments tation. Another notable observation was that the extent of but also diagnosed with osteoarthritis of the PIP joint. The proliferative, inflammatory synovitis, and the foreign debris researchers employed various clinical assessments, such as in the multinucleated cells correlated with the time between pain scores, range of motion, and patient satisfaction. Regarding the results of the study, the researchers reported the first surgery and the beginning of the research [51]. The silicon microparticles were evidence of continued degenera- that the level of pain was markedly lower during 18-month tion and erosion, and they were linked to the intense follow-up. Particularly, the decline was from a high of 7.2 particulate-tissue reaction that is referred to as metallosis prior to the operation to 0.4 after the operation [65]. Con- [53–57]. Other researchers report of symptomatic titanium cerning patient satisfaction, on the other hand, respondents returned a score of 4.8 on a five-point Likert scale, with the debris and metallosis from other joint arthroplasty surgeries, such as elbow procedures [58–62]. In evaluating pathology in majority of the individuals indicating that they would repeat bone formation and joint function, researchers focus on the the procedure [65]. However, despite these positive indica- presence of metal debris with an intense tissue reaction that tors, the researchers note that some fractures were reported also features fibrosis and giant cells [63]. Silicone implants between one and two years after surgery; moreover, some deformity was notable in the coronal plane, and the flexion are linked to various debilitating effects attributed to tissue Applied Bionics and Biomechanics 5 30° 90° Figure 4: NeuFlex silicone finger joint with the different motion angles. one implant fracture was observed at a 4-year follow-up. Over- all, the silicone dorsal approach is the most preferred tech- nique by surgeons owing to the relative ease with which the procedure can be conducted among other advantages. Figure 5: Avanta finger silicone implant. The last silicone implant technique is referred to as sili- cone with lateral approach. Various studies have tested the contracture also declined from 18 degrees in some patients to efficacy of this approach [80–82]. Similar to the volar 0 degrees [65]. Overall, while the silicon and volar approach approach, the lateral approach also has its merits; however, has been reported to result in high rates of patient satisfac- the primary advantage of this technique is the ability to tion, reduced pain, and sustained range of motion, some preserve both the flexor and extensor tendons [70]. The patients reported deformity and severely declined flexion approach involves making a longitudinal skin incision on contracture. the lateral region of the proximal phalanx, which is then Apart from the silicone with volar approach, implants curved dorsally over the central phalanx [70]. After the sur- feature silicone with the dorsal approach. This technique is geon cuts the transverse fibers of the underlying retinacular the most frequently deployed model by medical surgeons, ligament, they lift the extensor apparatus, and they dislocate and it involves either a v-shaped tenotomy or a longitudinal the tendon laterally to remain with the bony insertion of its extensor tendon-split that may be performed while preserv- central band [70]. The surgeon lifts the ligament complex ing the central band insertion [70, 71]. Various studies have in one triangular flap before they proceed to reflect it proxi- tested the efficacy of this approach with varying results [28, mally. The exercise involves making a V-shaped incision, 72–79]. With this model, a dorsal midline is made through ensuring that the cut’s longitudinal branch can fit perfectly the extensor tendon all the way to the central slip insertion into the dorsal margin of the collateral ligament [70]. The that is separated from the endpoint of the middle phalanx anterior-oblique branch divides the phalango-glenoidal liga- [70]. The surgeon lifts the distally placed extensor tendon ment from the collateral and supplementary collateral [70]. flap of the common extensor, which despite resulting in dis- To dislocate the joint laterally, the proximal insertion of location of the joint, it does not interfere with the central slip the dorsal capsule and the volar plate is released. The pivot insertion at the bottom of the middle phalanx [70]. Among point that enables this movement is the contralateral lateral the reasons why the dorsal approach is preferred by surgeons ligament complex [70]. In concluding the process, the sur- are the relative ease of the procedure, the possibility to pre- geon performs bone resectioning and reaming of the canals. serve collateral ligaments, access to the joint extensor muscles The actual implant of the pyro-carbon components follows, and tendons, and the ability of the surgeon to easily maneu- and the last step of the procedure involves reduction of the ver around articular surfaces while preparing implant canals joint and resuturing of the collateral ligament complex to [79]. In one study, involving this procedure, researchers merge it with the phalango-glenoidal component [70]. In sought to examine the outcomes of patients among whom one study, researchers examined the outcomes of lateral sur- the NeuFlex implant had been used for either a PIP or gical procedures for the PIP joint arthroplasty that had been MCP arthroplasty as a treatment of osteoarthritis [73]. The performed using silicone implants as a treatment approach researchers reported a significant gain in flexion and arc to degenerative osteoarthritis [80]. While the range of motion of between 61 and 65 degrees [73]. Similarly, the study motion in the preoperative period averaged at 38 , postoper- ° ° ° also reported a relatively low extension lag of 3 and 0 for the ative, the reported score was 68 [80]. The researchers con- MCP and PIP groups, respectively. While the overall rate of cluded that the procedure was not only minimally invasive satisfaction among patients in this study was 90 percent in but also effective since surgeons had sufficient exposure to the aftermath of the procedures, the scores slightly dropped the area being operated on. However, to improve lateral postsurgery to 88 and 87 for the MCP and PIP groups, respec- stability, patients’ contralateral ligaments needed to be tively [73]. However, the researchers also acknowledge that reinforced. 6 Applied Bionics and Biomechanics 4. Metal Implant Arthroplasty Biomaterials are classified into five major groups, including ceramics, composites, metals, polymers, and materials of bio- logical origin. However, other classification systems differen- tiate biomaterials on other bases, including inertness and smoothness of surface inertness and degree of porosity, chemical reactivity, and bioabsorbability [83]. These mate- rials have usage in joint replacement therapy with variable results. In clinical usage, metallic material can belong to either the first or second classification system. Different metals, such as cobalt-chrome or stainless steel, react in vary- ing ways with body tissues. The efficacy of a given type of metal in arthroplasty is a function of the ability to withstand or endure the surrounding biological conditions. With some metals, such as titanium, the oxide layer that covers their sur- face makes it possible for them to be in direct contact with the surrounding biological context without raising the risk of detrimental chemical reactions. This feature of titanium Figure 6: MatOrtho PIP finger joint replacement. and related metals is referred to as bioinertness. In bioengi- neering, surgeons are always weary of materials with chemi- cally reactive surfaces which have the potential to provoke goal of retaining the natural collateral ligaments, which tissue response that can lead to direct bonding to bone or would serve to provide the required stability and natural osteoid [83]. A case in point is calcium phosphate, contained functions. In a later study, researchers significantly improved in glass ceramics, hydroxyapatite, and bioglass. The problem the degree of osseointegration through a thermal titanium with bioabsorbable materials, on the other hand, is that they spray on the surface of the proximal component stem. Cur- are prone to degradation, meaning, with time, they are rently, this implant is being offered as PIP surface replace- replaced by regenerating tissue either in part or fully. ment arthroplasty (SRA) [7, 85]. Newer approaches have In medical practice, bioengineers have selected several since replaced hydroxyapatite-coated cobalt chrome bearing suitable metals. The most commonly deployed metals in on UHMWPE or pyrocarbon [9]. Some of the PIP implants medical practice, for this matter, comprise cobalt chrome, have been cemented and others not but coated with the titanium, and several of its alloys, gold, tantalum, surgical hydroxyapatite to allow bone integration [86]. These cemen- stainless steel, and mercury-based alloys [83]. Metals can be ted implants were facing problems such as pain, stiffness, and classified as either light or heavy, and this weight is a major loosening [86, 87]. A cementless cobalt-chromium metal issue in biological implants; hence, bioengineers have set against polyethylene prosthesis is coated with hydroxyapatite the limit of metal density for material that can be used in to accelerate bone integration called MatOrtho proximal implants at 5 g/cm . The lightest metals include aluminum interphalangeal (Mole Business Park, Leatherhead, UK), as and titanium, meaning the rest of the metals mentioned shown in Figure 6 [88]. The results if implanting cementless above comprise heavy metals. The least reactive type of metal against polymer finger joint could lead to problems such metals comprises those that occur as pure elements in nature. as pain, loosening, stiffness, instability, dislocated polyethylene Another notable feature regarding metals is that the majority insert, and dissociation of the whole implant [86, 88]. of these compounds have alloys, which reduce their purity. More important, such impurities significantly determine 4.1. Pyrocarbon Implant Arthroplasty. Pyrocarbon, according to researchers, is increasingly strong due to a synthetically both the physical and chemical properties of metals. Various aspects of metals, including weight, purity, and chemical coated graphite core. The core is formed by heating a hydro- reactivity, are considered prior to the selection of the best carbon gas to extremely high temperatures [9]. These com- alternative for use as implants. pounds are a form of pyrolytic carbon, and they appear as Bioengineering research relating to the use of metals in ceramic material [89]. Regarding pyrocarbon implants, the Ontario Medical Advisory Secretariat notes that the compo- finger joint arthroplasty began at the end of the 70s. Linsc- heid and Dobyns are credited with pioneering a novel design nents comprise a pyrolytic carbon coating measuring 0.42 in which they experimented with a cobalt chrome proximal mm in thickness over an appropriately shaped graphite sub- component and high molecular weight polyethylene strate. For improved joint connection, the implant features (HMWPE) [84]. These researchers felt that available options ball and socket articulates, which have stems that come in the shape of the corresponding bones of the joint; hence, they for patients were limited; hence, they sought to resolve some of the issues associated with previous researcher’s proposals. can be inserted without bone cement [89]. Concerning the Among these issues was the lack of stability and poor physi- regulatory status of pyrocarbon finger joint implants, the ological articulation, an increased laterally directed stress. To United States Food and Drug Administration first approved achieve their mission, the researchers continuously sought to the Ascension MCP in 2002, as shown in Figure 7, but the product was already in use in Europe following its earlier find ways of minimizing bony resection of the joints with the Applied Bionics and Biomechanics 7 Figure 7: The ascension MCP. approval in 1999. The second pyrocarbon, Ascension PIP, 6. MCP Joint Surface Replacement which was developed by Ascension Orthopedics Inc., also The MCP is a ball and socket joint that appears as a convex received approval in 2002, but USFDA directed that the use shape on the metacarpal head. The joint is surrounded by of the components be limited to humanitarian. The Swanson collateral ligaments. Rheumatoid arthritis patients usually implant remains the most commonly used finger joint require MCP replacement, and the procedure includes silas- implant. tic interpositional replacement and rebalancing of the under- lying soft tissue. Before a patient can be considered for this procedure, the surgeon must conduct a preoperative assess- 5. PIP Joint Surface Replacement ment. More importantly, the approach is usually applied in cases of osteo- and posttraumatic arthritis, and individuals The proximal interphalangeal joint plays a major role in the must have adequate soft tissue and sufficient underlying liga- kinetic chain. This joint is attributed to approximately 40 ments. For individuals with rheumatoid arthritis, the inci- percent of the total range of active motions [9, 84, 90–92]. dence of soft-tissue imbalance might be severe; hence, the The joint helps individuals to grab smaller things and to hold surgeon needs to determine whether correcting ulnar devia- objects with an irregular shape. The fixed center of the PIP tions and palmar subluxation deformities is possible. In other joint’s rotation falls at the proximal insertion of the collateral words, the physician needs to assess whether the joint will ligaments, whereby, according to Singh and Dias, at different remain intact after the procedure has been performed. The joint positions, the tension in the collateral ligaments does success rate of these procedures is reported to be increasingly not change. Destruction of this joint is usually attributed to high, with some studies reporting one revision out of 13 inflammation or degeneration [5]. With a finger tourniquet, joints five years postoperation [99]. In this study, the the surgical technique for a PIP joint surface replacement researchers developed an unconstrained surface MCP joint can be performed while a patient is under local anesthesia replacement with a polyethylene and metacarpal phalangeal [9]. With this procedure, the joint is essentially approached material, which were attached to uncemented finned dorsally, longitudinally, or laterally. Singh and Dias note that polyethylene plugs to generate some level of motion in the a longitudinal split of the extensor tendon is preferable [9]. components [99]. Apart from the aforementioned complica- Under this approach, the incision is made to the attachment tions, the researchers also observed that out of the 13 joints, of the central slip, with the aim of detaching it from the liga- two exhibited lucency in the area of the phalangeal compo- ments in the middle phalanx to access the underlying soft tis- nent, while one exhibited some degradation in the metacar- sue. A number of complications are reported with this pal component [99]. Subluxation of the unconstrained approach associated with anatomical alignment, tendon component was also reported by other researchers [100– repair, and careful balance of soft tissue [93–98]. More- 103]. Like is the case with PIP joint surface replacement over, Singh and Dias report that pyrocarbon implants have arthroplasty, MCP joint surface replacement arthroplasty been noted to result in squeaks, and surgeons need to has varying success rates since some patients are reported inform patients prior to conducting the procedure. Among to experience dislocations of unconstrained implants. the reasons why patients who undergo PIP pyrocarbion arthroplasty require revision surgery are poorly selected cases or inclusion of patients who do not fit the criteria, 7. Autologous Small Joint Arthroplasty poor surgical procedures, the use of inappropriate pros- thetic material, and poorly designed prosthetic components Compatibility has been a major concern when it comes to [9]. Overall, since patients who undergo PIP joint replace- PIP and MCP joint arthroplasty. In a response to the result- ment with pyracarbons are prone to various complications, ing challenge of noncompatible components that react with they should be monitored closely both in pre- and postop- the surrounding tissue, resulting in degradation, pain, and erative periods. reduced postoperation motion, researchers sought to find Singh and Dias note that, with PIP surface implants, an alternative approach to treatment [104–107]. Autologous physicians are increasingly concerned about the range of small joint arthroplasty specifically focused on developing a progressive loss that patients are likely to experience as the technique that was not only biocompatible but also provided implants settle. patients with potential immediate vascularity and possible 8 Applied Bionics and Biomechanics future growth. Goebell is credited for experimenting with the [3] L. W. Catalano Iii, A. C. Skarparis, S. Z. Glickel, O. A. Barron, D. Malley, and L. B. Lane, “Treatment of chronic, first free-nonvascularized autologous joint transfer in 1913 traumatic hyperextension deformities of the proximal inter- [108]. However, the procedure has limited application in phalangeal joint with flexor digitorum superficialis tenod- modern practice, which is attributed to articular cartilage esis,” The Journal of hand surgery, vol. 28, no. 3, pp. 448– necrosis [109]. In 1967, researchers attempted to perform a 452, 2003. vascularized joint transfer [110]. In the mid-seventies, a [4] N. M. Vranis, B. Marascalchi, and E. Melamed, “Trends in study reported the first successful free toe joint transfer proximal interphalangeal and metacarpophalangeal joint [111]. Studies that followed the initial research have reported arthroplasty utilization using statewide databases,” The Jour- joint space preservation and maintenance of the hyaline car- nal of Hand Surgery (Asian-Pacific Volume), vol. 25, no. 1, tilage [112–125]. Tsai et al. studied both autogenous vascu- pp. 39–46, 2020. larized and nonvascularized total joint transfers in the [5] D. Herren, “The proximal interphalangeal joint: arthritis and hands of Macaca fascicularis monkeys among whom second deformity,” EFORT open reviews, vol. 4, no. 6, pp. 254–262, toe PIP joints were transferred as grafts to the hand, while the excised finger joints were relocated to the foot as nonvascu- [6] S. Kamnerdnakta, H. E. Huetteman, and K. C. Chung, “Com- larized free grafts [112]. Postoperative exams were con- plications of proximal interphalangeal joint injuries: preven- ducted at 16 weeks to ten months, and the researchers tion and treatment,” Hand clinics, vol. 34, no. 2, pp. 267– report that due to necrosis and infection two of the nonvas- 288, 2018. cularized grafts had to be amputated. In a similar study, in [7] J. M. Adkinson and K. C. Chung, “Advances in small joint which researchers sought to gain joint stability, stress toler- arthroplasty of the hand,” Plastic and reconstructive surgery, ance, painless function range of motion, and growth vol. 134, no. 6, pp. 1260–1268, 2014. potential through free vascularized digital joint transfers, [8] A. Naylor, S. C. Talwalkar, I. A. Trail, and T. J. Joyce, “In vitro researchers reported that six out of the seven procedures wear testing of a CoCr-UHMWPE finger prosthesis with were successful [113]. hydroxyapatite coated CoCr stems,” Lubricants, vol. 3, no. 2, pp. 244–255, 2015. 8. Conclusion [9] H. Singh and J. J. Dias, “Surface replacement arthroplasty of the proximal interphalangeal and metacarpophalangeal PIP and MCP joint therapy in artificial finger joints have joints: the current state,” Indian journal of plastic surgery, come a long way from the time when amputation and vol. 44, no. 2, pp. 317–326, 2011. arthrodesis were the only options; however, even modern [10] J. J. Hage, “History off-hand: Bunnell’s no-man’s land,” The techniques still face problems related to reactive tissues, Hand, vol. 14, no. 4, pp. 570–574, 2019. reduced range of motion, and flexion and extension deficits. [11] W. L. Newmeyer III, “Joseph H. Boyes, MD, 1905–1995: a Swanson silicone implants remain popular, and physicians driving force in American hand surgery,” The Journal of hand prefer silicone with the dorsal approach during operation. surgery, vol. 30, no. 3, pp. 436–440, 2005. However, other approaches, particularly the pyrocarbon [12] J. H. Boyes, “Bunnell's surgery of the hand,” American Jour- implant arthroplasty, have also attracted the attention of nal of Physical Medicine & Rehabilitation, vol. 50, no. 6, practitioners. The least favored technique is the autologous p. 309, 1971. small joint arthroplasty. Future studies need to find ways of [13] M. L. Drake and K. A. Segalman, “Complications of small merging the increased range of motion associated with pyro- joint arthroplasty,” Hand Clinics, vol. 26, no. 2, pp. 205– carbon and silicone implants with the element of retained 212, 2010. vascularity associated with autologous small joint arthro- [14] I. Gibson, S. P. Chow, K. W. Lam et al., “The Development of plasty. The challenge that exists concerns problems of an Artificial Finger Joint,” in Bio-materials and prototyping applications in medicine, pp. 157–190, Springer, Boston, infections and articular cartilage necrosis associated with MA, 2008. attempted retention of vascularity. [15] R. E. Carroll and T. H. Taber, “Digital arthroplasty of the proximal interphalangeal joint,” JBJS, vol. 36, no. 5, Data Availability pp. 912–920, 1954. The data used to support the findings of this study are [16] J.-H. Song, J.-Y. Lee, Y.-G. Chung, and I.-J. Park, “Distal included within the article. interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses,” Archives of orthopaedic and trauma surgery, vol. 132, no. 5, pp. 663– Conflicts of Interest 669, 2012. The authors declare that they have no conflicts of interest. [17] G. Mantovani, W. Y. Fukushima, A. B. Cho, M. A. Aita, W. Lino Jr., and F. N. Faria, “Alternative to the distal inter- phalangeal joint arthrodesis: lateral approach and plate fixa- References tion,” The Journal of hand surgery, vol. 33, no. 1, pp. 31–34, [1] R. A. Berger, “A brief history of finger arthroplasty,” The Iowa 2008. Orthopaedic Journal, vol. 9, p. 77, 1989. [18] F. Villani, B. Uribe-Echevarria, and L. Vaienti, “Distal inter- [2] G. Yang, E. P. McGlinn, and K. C. Chung, “Management of phalangeal joint arthrodesis for degenerative osteoarthritis the stifffinger: evidence and outcomes,” Clinics in plastic sur- with compression screw: results in 102 digits,” The Journal gery, vol. 41, no. 3, pp. 501–512, 2014. of hand surgery, vol. 37, no. 7, pp. 1330–1334, 2012. Applied Bionics and Biomechanics 9 [19] O. Aliu, D. T. Netscher, and M. Peltier, “Failure of small joint [38] A. Swanson and G. Swanson, Eds., “Flexible implant arthro- arthrodesis from resorption around a compression screw in a plasty of the radiocarpal joint,” Seminars in arthroplasty, patient with lupus-associated arthritis mutilans: case report,” 1991. The Hand, vol. 3, no. 1, pp. 72–75, 2008. [39] A. B. Swanson, S. G. de Groot, and B. K. Maupin, “Flexible implant arthroplasty of the radiocarpal joint surgical tech- [20] M. S. Burman, “Vitallium cup arthroplasty of metacarpopha- langeal and interphalangeal joints of fingers,” Bulletin of the nique and long-term study,” Clinical Orthopaedics and Related Research, vol. 187, pp. 94–106, 1984. Hospital for Joint Diseases, vol. 1, pp. 79–89, 1940. [40] M. I. Rossello, M. Costa, and V. Pizzorno, “Experience of [21] P. Hernigou, “Smith–Petersen and early development of hip total wrist arthroplasty with silastic implants plus grommets,” arthroplasty,” International Orthopaedics, vol. 38, no. 1, Clinical orthopaedics and related research, vol. 342, pp. 64–70, pp. 193–198, 2014. [22] F. L. Liebolt, “The use of capsulectomy and arthroplasty for [41] R. A. Capone, “The titanium grommet in flexible implant limitation of finger motion,” Plastic and Reconstructive Sur- arthroplasty of the radiocarpal joint: a long-term review of gery, vol. 6, no. 1, p. 93, 1950. 44 cases,” Plastic and reconstructive surgery, vol. 96, no. 3, [23] E. W. Brannon and G. Klein, “Experiences with a finger-joint pp. 667–672, 1995. prosthesis,” Plastic and Reconstructive Surgery, vol. 24, no. 2, [42] A. B. Swanson, “Flexible implant arthroplasty for arthritic p. 224, 1959. finger joints,” Plastic and Reconstructive Surgery, vol. 51, [24] A. E. Flatt, “Restoration of rheumatoid finger-joint function,” no. 1, p. 105, 1973. JBJS, vol. 43, no. 5, pp. 753–774, 1961. [43] A. Swanson and G. de Groot Swanson, “Flexible implant [25] K. Vainio, “Vainio arthroplasty of the metacarpophalangeal arthroplasty in the rheumatoid metacarpophalangeal joint,” joints in rheumatoid arthritis,” Journal of Hand Surgery, Clinics in rheumatic diseases, vol. 10, no. 3, pp. 609–629, 1984. vol. 14, no. 2, pp. 367-368, 1989. [44] T. E. Gillespie, A. E. Flatt, Y. Youm, and B. L. Sprague, “Bio- [26] J. W. Tupper, “The metacarpophalangeal volar plate arthro- mechanical evaluation of metacarpophalangeal joint prosthe- plasty,” Journal of Hand Surgery, vol. 14, no. 2, pp. 371– sis designs,” Journal of Hand Surgery, vol. 4, no. 6, pp. 508– 375, 1989. 521, 1979. [27] A. B. Swanson, “Flexible implant resection arthroplasty,” The [45] H. Gellman, W. Stetson, R. H. Brumfield Jr., W. Costigan, Hand, vol. 4, no. 2, pp. 119–134, 1972. and S. H. Kuschner, “Silastic metacarpophalangeal joint [28] A. B. Swanson, “Silicone rubber implants for replacement of arthroplasty in patients with rheumatoid arthritis,” Clinical arthritic or destroyed joints in the hand,” Surgical Clinics of Orthopaedics and Related Research, vol. 342, pp. 16–21, 1997. North America, vol. 48, no. 5, pp. 1113–1127, 1968. [46] C. M. Jensen, M. E. Boeckstyns, and B. Kristiansen, “Silastic [29] A. Swanson, “Implant resection arthroplasty of the proximal arthroplasty in rheumatoid MCP-joints,” Acta Orthopaedica interphalangeal joint,” The Orthopedic clinics of North Amer- Scandinavica, vol. 57, no. 2, pp. 138–140, 1986. ica, vol. 4, no. 4, pp. 1007–1030, 1973. [47] A. Kay, J. Jeffs, and J. Scott, “Experience with silastic prosthe- [30] A. Swanson, “Finger joint replacement by silicone rubber ses in the rheumatoid hand. A 5-year follow-up,” Annals of implants and the concept of implant fixation by encapsula- the Rheumatic Diseases, vol. 37, no. 3, pp. 255–258, 1978. tion,” Annals of the rheumatic diseases, vol. 28, Suppl 5, [48] B. Weightman, S. Simon, R. Rose, I. Paul, and E. Radin, p. 47, 1969. “Environmental fatigue testing of silastic finger joint prosthe- [31] S. Takigawa, S. Meletiou, M. Sauerbier, and W. P. Cooney, ses,” Journal of Biomedical Materials Research, vol. 6, no. 4, “Long-term assessmentof swanson implant arthroplasty in pp. 15–24, 1972. the proximal interphalangeal joint of the hand,” The Journal [49] T. Joyce and A. Unsworth, “A literature review of" failures" of of hand surgery, vol. 29, no. 5, pp. 785–795, 2004. the Swanson finger prosthesis in the metacarpophalangeal [32] R. L. Linscheid, “Implant arthroplasty of the hand: retrospec- joint,” Hand surgery, vol. 7, no. 1, pp. 139–146, 2002. tive and prospective considerations,” The Journal of hand [50] R. Atkinson and R. Smith, “Silicone synovitis following sili- surgery, vol. 25, no. 5, pp. 796–816, 2000. cone implant arthroplasty,” Hand clinics, vol. 2, no. 2, [33] S. Braley, “The silicones as tools in biological engineering,” in pp. 291–299, 1986. Biomaterials, pp. 67–89, Springer, Boston, MA, 1965. [51] C. A. Peimer, J. Medige, B. S. Eckert, J. R. Wright, and C. S. Howard, “Reactive synovitis after silicone arthroplasty,” Jour- [34] A. Roberts, “Silicones and their application as implant mate- rials,” Bio-Medical Engineering, vol. 2, pp. 156–160, 1967. nal of Hand Surgery, vol. 11, no. 5, pp. 624–638, 1986. [52] D. E. Foliart, “Swanson silicone finger joint implants: a review [35] A. Swanson, B. Maupin, N. Gajjar, and G. de Groot Swanson, of the literature regarding long-term complications,” The “Flexible implant arthroplasty in the proximal interphalan- Journal of hand surgery, vol. 20, no. 3, pp. 445–449, 1995. geal joint of the hand,” Journal of Hand Surgery, vol. 10, no. 6, pp. 796–805, 1985. [53] C. Willis-Owen, G. Keene, and R. Oakeshott, “Early metallosis-related failure after total knee replacement: a [36] A. B. Swanson, S. G. de Groot, and H. Ishikawa, “Use of report of 15 cases,” The Journal of bone and joint surgery Brit- grommets for flexible implant resection arthroplasty of the ish volume, vol. 93, no. 2, pp. 205–209, 2011. metacarpophalangeal joint,” Clinical Orthopaedics and Related Research, vol. 342, pp. 22–33, 1997. [54] J. J. Jacobs, R. M. Urban, N. J. Hallab, A. K. Skipor, A. Fischer, and M. A. Wimmer, “Metal-on-metal bearing surfaces,” [37] K. Schmidt, R. Willburger, A. Ossowski, and R. Miehlke, JAAOS-Journal of the American Academy of Orthopaedic Sur- “The effect of the additional use of grommets in silicone geons, vol. 17, no. 2, pp. 69–76, 2009. implant arthroplasty of the metacarpophalangeal joints,” The Journal of Hand Surgery: British & European Volume, [55] B. Ollivere, C. Darrah, T. Barker, J. Nolan, and M. Porteous, vol. 24, no. 5, pp. 561–564, 1999. “Early clinical failure of the Birmingham metal-on-metal 10 Applied Bionics and Biomechanics [71] A. Chamay, “A distally based dorsal and triangular tendinous hip resurfacing is associated with metallosis and soft-tissue necrosis,” The Journal of bone and joint surgery British vol- flap for direct access to the proximal interphalangeal joint,” ume, vol. 91, no. 8, pp. 1025–1030, 2009. Annales de chirurgie de la main: organe officiel des societes de chirurgie de la main, vol. 7, no. 2, pp. 179–183, 1988. [56] R. M. Urban, J. J. Jacobs, M. J. Tomlinson, J. Gavrilovic, J. Black, and M. Peoc'h, “Dissemination of wear particles to [72] W. Daecke, B. Kaszap, A. Martini, F. Hagena, B. Rieck, and the liver, spleen, and abdominal lymph nodes of patients with M. Jung, “A prospective, randomized comparison of 3 types hip or knee replacement,” JBJS, vol. 82, no. 4, pp. 457–477, of proximal interphalangeal joint arthroplasty,” The Journal 2000. of hand surgery, vol. 37, no. 9, pp. 1770–1779.e3, 2012. [57] J. J. Jacobs and N. J. Hallab, “Loosening and osteolysis associ- [73] S. Namdari and A.-P. C. Weiss, “Anatomically neutral sili- ated with metal-on-metal bearings: a local effect of metal cone small joint arthroplasty for osteoarthritis,” The Journal hypersensitivity?,” JBJS, vol. 88, no. 6, pp. 1171-1172, 2006. of hand surgery, vol. 34, no. 2, pp. 292–300, 2009. [58] A. Asahina, H. Fujita, S. Fukuda et al., “Extensive skin pig- [74] D. B. Herren and B. R. Simmen, “Palmar approach in flexible mentation caused by deposits of metallic particles following implant arthroplasty of the proximal interphalangeal joint,” total elbow arthroplasty: metallosis or not?,” British Journal Clinical Orthopaedics and Related Research, vol. 371, of Dermatology, vol. 157, no. 5, pp. 1074–1076, 2007. pp. 131–135, 2000. [59] I. Degreef, R. Sciot, and L. De Smet, “Metallosis in revision [75] C. Mathoulin and A. Gilbert, “Arthroplasty of the proximal total elbow arthroplasty. Complications and staging method,” interphalangeal joint using the Sutter implant for traumatic Acta orthopaedica belgica, vol. 74, no. 6, p. 753, 2008. joint destruction,” Journal of Hand Surgery, vol. 24, no. 5, pp. 565–569, 1999. [60] C. Khoo, J. Davison, and M. Ali, “Tissue reaction to titanium debris following Swanson arthroplasty in the hand: a report [76] J. Silva, R. Schwanke, M. Vicente, and M. Fridman, “Arthro- of two cases,” Journal of Hand Surgery, vol. 29, no. 2, plasty with silicone implant in post traumatic lesions of the pp. 152–154, 2004. proximal interphalangeal joint,” Revista Brasileira de Ortope- dia, vol. 33, pp. 79–82, 1998. [61] A. S. Sayed-Noor and G. O. Sjödén, “Severe metallosis after total elbow arthroplasty—a case report,” The Hand, vol. 5, [77] B. Cesari and J.-Y. Alnot, “Proximal interphalangeal joint no. 1, pp. 86–89, 2010. implant arthroplasty for degenerative or post-traumatic arthristis,” MAIN-PARIS-, vol. 2, pp. 85–96, 1997. [62] K. V. Voellmicke, M. Bansal, and M. J. O'Malley, “Failed first metatarsophalangeal arthroplasty salvaged by hamstring [78] V. D. Pellegrini Jr. and R. I. Burton, “Osteoarthritis of the interposition arthroplasty: metallic debris from grommets,” proximal interphalangeal joint of the hand: arthroplasty or The American Journal of Orthopedics, vol. 37, no. 2, fusion?,” The Journal of hand surgery, vol. 15, no. 2, pp. E42–E45, 2008. pp. 194–209, 1990. [63] I. K. Choudhry, J. M. Wilson, and P. J. Stern, “Metallosis fol- [79] K. D. Bickel, “The dorsal approach to silicone implant arthro- lowing silicone metacarpophalangeal joint arthroplasties plasty of the proximal interphalangeal joint,” The Journal of with grommets: case report,” The Hand, vol. 7, no. 2, hand surgery, vol. 32, no. 6, pp. 909–913, 2007. pp. 207–209, 2012. [80] M. Merle, F. Villani, B. Lallemand, and L. Vaienti, “Proximal [64] T. Joyce and A. Unsworth, “NeuFlex metacarpophalangeal interphalangeal joint arthroplasty with silicone implants prostheses tested in vitro,” Proceedings of the Institution of (NeuFlex) by a lateral approach: a series of 51 cases,” Journal Mechanical Engineers, Part H: Journal of Engineering in Med- of Hand Surgery (European Volume), vol. 37, no. 1, pp. 50–55, icine, vol. 219, no. 2, pp. 105–110, 2005. 2012. [65] I. R. Proubasta, C. G. Lamas, L. Natera, and A. Millan, “Sili- [81] A. Stahlenbrecher and J. Hoch, “Proximal interphalangeal cone proximal interphalangeal joint arthroplasty for primary joint silicone arthroplasty–comparison of Swanson and Neu- osteoarthritis using a volar approach,” The Journal of hand Flex implants using a new evaluation score,” Handchirurgie, surgery, vol. 39, no. 6, pp. 1075–1081, 2014. Mikrochirurgie, plastische Chirurgie: Organ der Deutschspra- chigen Arbeitsgemeinschaft fur Handchirurgie: Organ der [66] M. Lautenbach, S. Kim, M. Berndsen, and A. Eisenschenk, Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie “The palmar approach for PIP-arthroplasty according to der Peripheren Nerven und Gefasse: Organ der V, vol. 41, Simmen: results after 8 years follow-up,” Journal of Orthopae- no. 3, p. 156, 2009. dic Science, vol. 19, no. 5, pp. 722–728, 2014. [82] J. J. Hage, E. P. Yoe, J. P. Zevering, and P. J. de Groot, “Prox- [67] S. Bouacida, C. Lazerges, B. Coulet, and M. Chammas, imal interphalangeal joint silicone arthroplasty for posttrau- “Arthroplastie interphalangienne proximale avec implants matic arthritis,” The Journal of hand surgery, vol. 24, no. 1, Neuflex : interet de la voie d'abord palmaire avec reeduca- pp. 73–77, 1999. tion precoce,” Chirurgie de la Main, vol. 33, no. 5, pp. 350– 355, 2014. [83] Y. T. Konttinen, I. Milošev, R. Trebše et al., “Metals for joint replacement,” in Joint Replacement Technology, P. A. Revell, [68] H. H. Lin, J. D. Wyrick, and P. J. Stern, “Proximal interpha- Ed., pp. 81–151, Woodhead Publishing, 2014. langeal joint silicone replacement arthroplasty: clinical results using an anterior approach,” The Journal of hand surgery, [84] R. Linscheid and J. Dobyns, Eds., “Total joint arthroplasty. The hand,” Mayo Clinic Proceedings, 1979. vol. 20, no. 1, pp. 123–132, 1995. [69] L. H. Schneider, Ed., “Proximal interphalangeal joint arthro- [85] R. L. Linscheid, P. M. Murray, M.-A. Vidal, and R. D. Becken- plasty: the volar approach,” Seminars in arthroplasty, 1991. baugh, “Development of a surface replacement arthroplasty for proximal interphalangeal joints,” The Journal of hand sur- [70] M. Ceruso, S. Pfanner, and C. Carulli, “Proximal interphalan- gery, vol. 22, no. 2, pp. 286–298, 1997. geal (PIP) joint replacements with pyrolytic carbon implants in the hand,” EFORT Open Reviews, vol. 2, no. 1, pp. 21–27, [86] B. R. Johnstone, M. Fitzgerald, K. R. Smith, and L. J. Currie, 2017. “Cemented versus uncemented surface replacement Applied Bionics and Biomechanics 11 mal interphalangeal and metacarpophalangeal joint replace- arthroplasty of the proximal interphalangeal joint with a mean 5-year follow-up,” The Journal of hand surgery, ments,” American Journal of Roentgenology, vol. 197, no. 5, vol. 33, no. 5, pp. 726–732, 2008. pp. 1177–1181, 2011. [87] C. D. Jennings and D. P. Livingstone, “Surface replacement [102] A. Nakanishi, K. Kawamura, S. Omokawa, T. Shimizu, and arthroplasty of the proximal interphalangeal joint using the Y. Tanaka, “Reconstruction of a metacarpal head defect due PIP-SRA implant: results, complications, and revisions,” to bite injury: two case reports,” Case Reports in Plastic Sur- The Journal of hand surgery, vol. 33, no. 9, pp. 1565. e1– gery and Hand Surgery, vol. 5, no. 1, pp. 62–67, 2018. 1565. e11, 2008. [103] D. R. Dickson, R. Badge, D. Nuttall et al., “Pyrocarbon meta- [88] O. Flannery, O. Harley, R. Badge, A. Birch, D. Nuttall, and carpophalangeal joint arthroplasty in noninflammatory I. Trail, “MatOrtho proximal interphalangeal joint arthro- arthritis: minimum 5-year follow-up,” The Journal of Hand plasty: minimum 2-year follow-up,” Journal of Hand Surgery Surgery, vol. 40, no. 10, pp. 1956–1962, 2015. (European Volume), vol. 41, no. 9, pp. 910–916, 2016. [104] D. Muder, O. Nilsson, and T. Vedung, “Reconstruction of fin- [89] Medical Advisory Secretariat, “Pyrocarbon finger joint ger joints using autologous rib perichondrium–an observa- implant: an evidence-based analysis,” Ontario health technol- tional study at a single centre with a median follow-up of 37 ogy assessment series, vol. 4, no. 6, pp. 1–31, 2004. years,” BMC Musculoskeletal Disorders, vol. 21, pp. 1–12, [90] P. W. Jordaan, D. McGuire, and M. W. Solomons, “Sur- face replacement proximal interphalangeal joint arthro- [105] H. J. Boulas, “Autograft replacement of small joint defects in plasty: a case series,” The Hand, vol. 14, no. 5, pp. 669– the hand,” Clinical Orthopaedics and Related Research, 674, 2019. vol. 327, pp. 63–71, 1996. [91] D. Beevers and B. Seedhom, “Metacarpophalangeal joint [106] H. Baltzer and S. L. Moran, “Joint replacement arthroplasty: prostheses: a review of past and current designs,” Proceedings is it ever indicated in PIP joint fracture-dislocations?,” in of the Institution of Mechanical Engineers, Part H: Journal of PIP Joint Fracture Dislocations, pp. 155–170, Springer, Engineering in Medicine, vol. 207, no. 4, pp. 195–206, 1993. 2016. [92] A. Watts, A. Hearnden, I. Trail, M. Hayton, D. Nuttall, and [107] J. I. Billig, J. S. Nasser, and K. C. Chung, “National prevalence J. Stanley, “Pyrocarbon proximal interphalangeal joint of complications and cost of small joint arthroplasty for hand arthroplasty: minimum two-year follow-up,” The Journal of osteoarthritis and post-traumatic arthritis,” The Journal of hand surgery, vol. 37, no. 5, pp. 882–888, 2012. Hand Surgery, vol. 45, no. 6, pp. 553.e1–553.e12, 2020. [93] K. C. Chung, A. N. Ram, and M. J. Shauver, “Outcomes of [108] A. B. Gill, “Transplantation of entire bones with their joint pyrolytic carbon arthroplasty for the proximal interphalan- surface: A. Bruce Gill MD (1876-1965). The 6th president geal joint,” Plastic and reconstructive surgery, vol. 123, no. 5, of the AAOS 1937,” Clinical orthopaedics and related pp. 1521–1532, 2009. research, vol. 466, no. 1, pp. 47–49, 2008. [94] S. Ono, M. J. Shauver, K. W. Chang, and K. C. Chung, “Out- [109] W. C. Graham, “Transplantation of joints to replace diseased comes of pyrolytic carbon arthroplasty for the proximal or damaged articulations in the hands,” The American Jour- interphalangeal joint at 44 months mean follow-up,” Plastic nal of Surgery, vol. 88, no. 1, pp. 136–141, 1954. and reconstructive surgery, vol. 129, no. 5, pp. 1139–1150, [110] H. Buncke Jr., A. Daniller, W. Schulz, R. Chase, and H. J. Buncke Jr., “The fate of autogenous whole joints transplanted [95] T. M. Sweets and P. J. Stern, “Pyrolytic carbon resurfacing by microvascular anastomoses,” Plastic and Reconstructive arthroplasty for osteoarthritis of the proximal interphalan- Surgery, vol. 39, no. 4, pp. 333–341, 1967. geal joint of the finger,” JBJS, vol. 93, no. 15, pp. 1417–1425, [111] G. Foucher, F. Van Genechten, M. Merle et al., “The transfer from toe in reconstructive surgery of the hand : about seventy [96] B. R. Branam, H. G. Tuttle, P. J. Stern, and L. Levin, “Resurfa- cases toe-to-hand transfers in reconstructive surgery of the cing arthroplasty versus silicone arthroplasty for proximal hand : experience with seventy-one cases (In French),” interphalangeal joint osteoarthritis,” The Journal of hand sur- Annales de chirurgie de la main: organe officiel des societes gery, vol. 32, no. 6, pp. 775–788, 2007. de chirurgie de la main, vol. 3, no. 2, pp. 124–138, 1984. [97] K. Chan, O. Ayeni, L. McKnight, T. A. Ignacy, F. Farrokhyar, [112] T.-M. Tsai, L. Ogden, S. H. Jaeger, and K. Okubo, “Experi- and A. Thoma, “Pyrocarbon versus silicone proximal inter- mental vascularized total joint autografts–a primate study,” phalangeal joint arthroplasty: a systematic review,” Plastic The Journal of Hand Surgery, vol. 7, no. 2, pp. 140–146, 1982. and reconstructive surgery, vol. 131, no. 1, pp. 114–124, 2013. [113] B. M. O'Brien, J. S. Gould, W. A. Morrison, R. C. Russell, [98] D. McGuire, C. White, S. Carter, and M. Solomons, “Pyrocar- A. M. MacLeod, and J. J. Pribaz, “Free vascularized small joint bon proximal interphalangeal joint arthroplasty: outcomes of transfer to the hand,” The Journal of Hand Surgery, vol. 9, a cohort study,” Journal of Hand Surgery (European Volume), no. 5, pp. 634–641, 1984. vol. 37, no. 6, pp. 490–496, 2012. [114] T.-M. Tsai and R. Singer, “Elective free vascularized double [99] D. Harris and J. Dias, “Five-year results of a new total replace- transfer of toe joint from second toe to proximal interphalan- ment prosthesis for the finger metacarpo-phalangeal joints,” geal joint of index finger: a case report,” The Journal of hand Journal of Hand Surgery, vol. 28, no. 5, pp. 432–438, 2003. surgery, vol. 9, no. 6, pp. 816–820, 1984. [100] M. A. Syed, A. Smith, and H. Benjamin-Laing, “Pyrocarbon [115] T. Tsai, R. Singer, E. Elliott, and H. Klein, “Immediate free implant fracture after metacarpophalangeal joint arthro- vascularized joint transfer from second toe to index finger plasty: an unusual cause for early revision,” Journal of Hand proximal interphalangeal joint: a case report,” Journal of Surgery (European Volume), vol. 35, no. 6, pp. 505-506, 2010. Hand Surgery, vol. 10, no. 1, pp. 85–89, 1985. [101] J. M. Petscavage, A. S. Ha, and F. S. Chew, “Arthroplasty of [116] C. Y. Y. Loh, C.-C. Hsu, C.-H. Lin et al., “Customizing exten- the hand: radiographic outcomes of pyrolytic carbon proxi- sor reconstruction in vascularized toe joint transfers to finger 12 Applied Bionics and Biomechanics proximal interphalangeal joints: a strategic approach for cor- recting extensor lag,” Plastic and Reconstructive Surgery, vol. 139, no. 4, pp. 915–922, 2017. [117] N. Tsubokawa, T. Yoshizu, and Y. Maki, “Long-term results of free vascularized second toe joint transfers to finger prox- imal interphalangeal joints,” The Journal of hand surgery, vol. 28, no. 3, pp. 443–447, 2003. [118] T.-M. Tsai, J. B. Jupiter, J. E. Kutz, and H. E. Kleinert, “Vas- cularized autogenous whole joint transfer in the hand–a clin- ical study,” Journal of Hand Surgery, vol. 7, no. 4, pp. 335– 342, 1982. [119] A. Berger and R. Hierner, “Long-term results after vascular- ized joint transfer for finger joint reconstruction,” in Innova- tions in Plastic and Aesthetic Surgery, pp. 95–103, Springer, [120] S. H.-T. Chen, F.-C. Wei, H.-C. Chen, V. R. Hentz, D. C. Chuang, and M.-C. Yeh, “Vascularized toe joint transfer to the hand,” Plastic and reconstructive surgery, vol. 98, no. 7, pp. 1275–1284, 1996. [121] L. Squitieri and K. C. Chung, “A systematic review of out- comes and complications of vascularized toe joint transfer, silicone arthroplasty, and PyroCarbon arthroplasty for post- traumatic joint reconstruction of the finger,” Plastic and reconstructive surgery, vol. 121, no. 5, pp. 1697–1707, 2008. [122] K. Kimori, Y. Ikuta, O. Ishida, M. Ichikawa, and O. Suzuki, “Free vascularized toe joint transfer to the hand. A technique for simultaneous reconstruction of the soft tissue,” Journal of Hand Surgery, vol. 26, no. 4, pp. 314–320, 2001. [123] C.-C. Hsu, C. Y. Y. Loh, D. Kao, S. L. Moran, and Y.-T. Lin, “The impact of transferred vascularized toe joint length on motion arc of reconstructed finger proximal interphalangeal joints: a cadaveric study,” Journal of Hand Surgery (European Volume), vol. 42, no. 8, pp. 789–793, 2017. [124] C.-H. Lin, P.-L. Tang, and C.-H. Lin, “Second toe extensor digitorum brevis provides a simultaneous abductorplasty to free vascularized metatarsophalangeal joint transfer for post- traumatic thumb composite metacarpophalangeal joint defect,” Journal of Trauma and Acute Care Surgery, vol. 66, no. 5, pp. 1374–1378, 2009. [125] M. Liu, J. Jia, and Z. Hou, “Clinical observation of traumatically-damaged joint after its repair with transplanta- tion of allogenic joint,” Zhongguo xiu fu chong jian wai ke za zhi= Zhongguo xiufu chongjian waike zazhi= Chinese journal of reparative and reconstructive surgery, vol. 21, no. 8, pp. 797–800, 2007. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Applied Bionics and Biomechanics Hindawi Publishing Corporation

Silicone and Pyrocarbon Artificial Finger Joints

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Copyright © 2021 F. A. Alnaimat et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Applied Bionics and Biomechanics Volume 2021, Article ID 5534796, 12 pages https://doi.org/10.1155/2021/5534796 Review Article 1 1 2 2 3 F. A. Alnaimat , H. A. Owida, A. Al Sharah, M. Alhaj, and Mohammad Hassan Medical Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan Computer Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan Civil Engineering, Faculty of Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan Correspondence should be addressed to F. A. Alnaimat; f.alnaimat@ammanu.edu.jo Received 10 February 2021; Revised 23 May 2021; Accepted 27 May 2021; Published 4 June 2021 Academic Editor: Juan Carlos Prados-Frutos Copyright © 2021 F. A. Alnaimat et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Artificial finger joint design has been developed through different stages through the past. PIP (proximal interphalangeal) and MCP (metacarpophalangeal) artificial finger joints have come to replace the amputation and arthrodesis options; although, these artificial joints are still facing challenges related to reactive tissues, reduced range of motion, and flexion and extension deficits. Swanson silicone artificial finger joints are still common due to the physician’s preferability of silicone with the dorsal approach during operation. Nevertheless, other artificial finger joints such as the pyrocarbon implant arthroplasty have also drawn the interests of practitioners. Artificial finger joint has been classified under three major categories which are constrained, unconstrained, and linked design. There are also challenges such as concerns of infections and articular cartilage necrosis associated with attempted retention of vascularity. In addition, one of the main challenges facing the silicone artificial finger joints is the fracture occurring at the distal stem with the hinge. The aim of this paper is to review the different artificial finger joints in one paper as there are few old review papers about them. Further studies need to be done to develop the design and materials of the pyrocarbon and silicone implants to increase the range of motion associated with them and the fatigue life of the silicone implants. was attributed to a lack of understanding of the mechanics 1. Introduction of small joints and the use of ineffective interpositional mate- Orthopedic surgeons treat patients with rheumatoid and rials [7, 13]. Similarly, researchers note that earlier proce- osteoarthritic hand deformities from time to time. These dures were prone to various complications, including the deformities are distal to the wrist in the proximal interpha- lack of functional motion, loose implants, recurrent joint deformity, component wear, and component fractures, langeal (PIP) and metacarpophalangeal (MCP) joint [1–7]. The PIP joint links the first and second phalanges of the fin- which led to revision surgeries [14]. Most practitioners dur- ger [8]. The MCP, on the other hand, is a condylar, ball, and ing this time are also reported to have preferred arthrodesis socket joint that has a concave-shaped proximal phalanx sur- or amputation [15]. The major complications associated with face and convex-shaped metacarpal anterior [9]. Arthroplas- early PIP and MCP joint treatment in artificial finger joint tic surgery became the standard approach to the treatment of approaches have been overcome through more sophisticated these deformities in the 70s and 80s. Prior to this time, prac- techniques, improved understanding of the joint’s anatomy, titioners supported nonoperative interventions for arthritic and better prosthetic compounds, but modern treatments hand deformities, arguing that if surgical intervention trans- still report varying degrees of success among patients during formed into the standard intervention for proximal joints, postoperative follow-ups. The aim of this article is to review such as the elbow and the shoulder, it would prevent the the different artificial finger joints in one paper as there are gravity-induced deformities of the hand [10–12]. However, few old review papers about them. Review papers about arti- it is important to note that early small joint arthroplasty ficial finger joints are not very numerous and most of them was characterized by poor implant design, an aspect that are evaluating specific finger joint instead of reviewing all 2 Applied Bionics and Biomechanics Liebolt’s footsteps, Caroll and Taber sought to find out if finger joints, their materials, and the failures associated with them. resection could be carried out, but the latter study did not combine soft tissue interposition with long-term postopera- tive digital traction in patients with ankylosed PIP joint 2. Resection/Interposition Arthroplasty [15]. Until this time, as the researchers report, studies had As noted earlier, severe arthritic conditions of the PIP joint not attempted to replace joint arthrodesis in the flexed posi- have been a recurrent problem among patients. The most tion of function [15]. To be considered for treatment, a common treatment approach to this ailment before 1914 patient had to exhibit ankyloses in a position of great defor- mity, had to have perfectly functioning tendons that produce was arthrodesis [1]. Arthrodesis of the distal interphalangeal (DIP) joints has a wide history as with a different range of motion in the middle joint, and be motivated to regain mobility [15]. Caroll and Taber reported that 83 percent of techniques including screw or plate fixation, crossed Kirsch- ner wires (K-wires), and external fixation, as shown in patients had notable improvement, but the process required Figure 1 [16–18]. Bunnell, who led the advocacy of this ther- closely supervised rehabilitation. As knowledge on digital joint replacement grew, apy, felt that patients with an ankylosed and malpositioned joint fared well after arthrodesis [12]. However, following researchers worked towards total replacement. In 1959, soldier’s devastating injuries, including deformed MCP and Brannon and Klein achieved this milestone by applying total PIP joints, the demand for improved therapy was high, replacement in 14 soldiers on active duty [23]. The approach prompting researchers to look for alternative approaches. taken by the researchers included a metal-hinged type of prosthesis, which the researchers used as a replacement for Usually, the therapy using arthrodesis will cause osteolysis failure of the surrounding bone as happened previously, lim- damaged joint [23]. The objective was to restore the function iting finger joint motion, infection, pain, and breakage [5, 13, of a destroyed part of a joint partially. However, the proce- 19]. Particularly, researchers sought to improve the func- dure required patients’ nerves, blood supply, and tendons tional range of finger motion among individuals with post- to be intact; moreover, the individuals had to be motivated. Some notable complications had to be overcome, including traumatic degenerative changes in the MCP and PIP joints [1]. According to Berger, some evidence exists of a number loose screws and sunken prostheses [23]. The researchers of researchers’ attempts to probe resection arthroplasty with reported that out of the 12 soldiers, 10 regained a painless various soft tissue interposition techniques [1]. motion within a functional range; moreover, the hand’s cos- In the 1940s, the calls for improved therapy heightened metic appearance was also improved [23]. However, later follow-ups on these patients reduced the efficacy of the treat- due to the injuries suffered during the Second World War [1, 7]. Particularly, Adkinson and Chung report about the ment, with the results showing implant loosening and frac- introduction of biologically inert Vitallium caps as a replace- tures [7]. Brannon and Klein’s treatment was modified two years later in 1961 by Flat, who sought to improve the rota- ment of the PIP and MCP joints [7]. The approach taken by researchers in this new form of therapy was modelled on tional stability of the hand [24]. With PIP joints, the study outlined three prerequisites, namely, joint ankyloses at dys- arthroplasty techniques in the lower extremities [20]. Vital- lium cups were favored because they were not only inert functional positions, significant joint damage, and persistent but also nonreactive [9]. Moreover, the approach was also swan-neck deformity. With MCP joints, on the other hand, a part from severe damage, as was the case with PIP joints, the attributed to increased motion in the connected joints, but the level of stability was low [9]. It is important to note that other prerequisites for the procedure were persistent ulnar drift and palmar joint dislocation [24]. In both PIP and researchers had previously experimented with Vitallium, cobalt-chromium alloy cups in hip arthroplasty between MCP joints, prosthetic replacement required sufficient mus- 1937 and 1939 [21]. Ineffective earlier approaches to MCP cle power for joint control [24]. However, as was the case with Brannon and Klein’s approach, patient follow-ups in and PIP joint therapy, including replacement with Vitallium cups and arthrodesis, paved the way for modern surface Flatt’s study also revealed some complications, including phalangeal fracture, boutonniere deformity, and poor or total replacement arthroplasty. At the beginning of the 50s, researchers began to look for lack of voluntary control [24]. Total digital joint replace- alternatives to Vitallium cups. Among these attempts were ments were initially faced with several complications that reduced the efficacy of the studies. Liebolt’s recommendations following successful procedures on soldiers injured during the Second World War [22]. Lie- MCP joint resection arthroplasty was first performed at the beginning of the 60s. Fowler is credited with pioneering bolt’s treatment was split into two phases. In the first phase, the process involved a capsulectomy, a procedure that saw research into this area, but other researchers, including Tup- surgeons divide collateral ligaments as well. In the event, per and Vainio, soon followed with a similar approach [25, 26]. Berger reports that the techniques proposed by these articular cartilage had been destroyed, and the surgeon could resect either the distal or the proximal surface of the joint researchers were notable contributions to the medical field’s [22]. In the second phase, the patients need to have postoper- attempt s to reduce pain among patients with severely degen- ative treatment by the physician in which it consists of daily erated MCP joints [1]. Nonetheless, the approaches were passive motion for three days and then active and passive associated with joint instability, and they are mostly motion four times daily done by the patient [22]. The objec- conducted in salvage situations. Modern practice of small tive was for the patient to develop between 30 degrees and 70 joint arthroplasty features several approaches, which will be degrees postoperative range of motion. In 1954, following in explored further below. Applied Bionics and Biomechanics 3 (a) (b) (c) Figure 1: Arthrodesis of finger joint such as (a) Kirschner wires (K-wires), (b) external fixation, and (c) screw fixation. 3. Silicone Implant Arthroplasty a one-piece heat-vulcanized implant could increasingly resist wear and tear more than either hand-molded or hand-carved When synthetic materials emerged as viable materials in implants [30]. More progress was made in the 80s through prosthetic surgery, researchers sought to experiment with continued experimentation. them in resection arthroplasty. The application of these Researchers in the 80s sought to enhance the flexion materials to the restoration of unstable or stifffingers was capabilities of the Swanson implants. Particularly, while particularly sought since finger joints presented one of the some researchers added metal grommets at the stem hub of most difficult areas for reconstructive surgery. Swanson is the interface of the Swanson implants to halt bone erosion, inarguably the pioneer researcher who ushered in the mod- as shown in Figure 2 [35], others sought the same approach, ern era of small joint arthroplasty [7]. Particularly, Swanson’s but their intent was to prevent fracturing of implants [36]. In revolutionary idea involved the silicone spacer [27–31]. In the first study [35], the researchers reported that patients this application, the researcher designed stems of the con- exhibited increased motion and a more functional arc; more- strained Swanson implant to operate as a piston within the over, the level of pain relief was also notable [35]. However, joint [32]. Deployment of silicone rubber for implants as a the researchers observed a high rate of complications among patients who underwent implant reconstruction to correct replacement for damaged joints had been suggested following Swanson’s previous experience regarding the rheumatoid swan-neck deformities [35]. In the second study, development of an intramedullary-stemmed silicone rubber on the other hand, no particulate synovitis and infection were implant, which had been designed to protect the long bone reported; moreover, the researchers observed favorable bone following amputation in the lower extremity [30]. Previous remodeling, with the experiment group showing better results concerning improved bone preservation at the meta- researchers had also affirmed the efficacy of silicone rubber as a unique implant material within the family of silicones physeal and midshaft levels [36]. However, the researchers [33, 34]. The material combined organic and inorganic ele- cautioned that the procedure required proper surgical staging ments, meaning that by fusing silicone and oxygen atoms and optimal preoperative and postoperative techniques [36]. to which organic groups were attached, one could merge In a recent study, researchers reported that the additional use of grommets in the MP joint arthroplasty was attributed to a the inertness of quartz with the fabrication character of plas- tics. Silicone implants were preferred because of their stabil- slight reduction in reactive osteolysis as the components ity, slow rate of deterioration, and nonadhesiveness [30]. acted by cushioning the spacers from breaking; moreover, Moreover, Swanson noted that these compounds had not the grommets were also noted to reduce pain [37]. Applica- only good flexion but also damped force; however, their tion of grommets has also been tested in other joints, includ- ing the wrist [38–41]. application could only be termed optimal if the operation found a way to contain a reported fragility, which increased Overall, the application of silicone implants in research, the compound susceptibility to tear. To overcome these dis- with or without grommets, has been successful in not only advantages, Swanson focused on designing the implant cor- PIP and MCP joints but also other joints, such as the wrist; rectly, with the aim of improving the implant flexural however, the problem of implant fracture persists in these studies. This fracture of the silicone artificial joint could start durability. Results from machine experiments revealed that 4 Applied Bionics and Biomechanics Figure 2: Swanson finger implant with metal grommets. Figure 3: Fatigue fracture of Swanson finger implant at the junction of hinge and stem. with small cut (initial cracks) caused by bone spurs from the bones in the finger or during the insertion the implant reaction to the implant and debris from the degenerating sil- icone. The NeuFlex, as shown in Figure 4, is another silicone could face some damages [42]. Another cause of damage is that the silicone artificial finger joint flexes at the stem implant for MCP and PIP Finger Joints which is made from more than the hinge part of the implant [42–44]. Most of silicone. The NeuFlex metacarpophalangeal joint was tested the Swanson artificial finger joint fractures happened at in vitro using finger simulator, and there was imminent the junction of the distal stem and the hinge, as shown in fracture of the prosthesis across the pivot of the central hinge section [64]. Figure 3 [45–48]. Silicone synovitis is not that popular with the Swanson finger joint in comparison with the other PIP joint implant arthroplasty features various patient silicone implants [49]. and finger characteristics. One common approach is the sili- One problem with silicone implants regards inflamma- cone with volar approach, with which various researchers tory reactions. Some studies have reported increased inflam- have experimented [5, 65–69]. The objectives of existing studies vary from one study to another. In one study, matory reactions attributed to the debris from small joint implants that essentially incite the symptomatic reactions, researchers sought to assess the clinical and radiographic causing pain [50–52]. After successful silicone rubber outcomes on the short-term concerning PIP joint implants implants, some patients have been reported to revisit hospi- that had been conducted using a volar approach [65]. In a tals because of swellings and discomfort [51]. In one study, related study, researchers sought to find out whether PIP joint arthroplasty through a volar approach preserved the Peimer et al. used a sample comprising such patients. The study group encompassed various types of silicone arthro- patient’s extensor apparatus that is necessary if early rehabil- plasty, including lunate, scaphoid, scapholunate, wrist, fin- itation was to be achieved [67]. Proubasta et al. [65] com- ger, trapezium, and ulnar head [51]. The patients had an prised Avanta silicone implants, as shown in Figure 5, established erosive osteolysis, which was ascertained through which had been deployed as a replacement of the PIP joints of 26 patients. To be included in the study, patients had to X-ray films; similarly, the study reported that progressive damage continued with time after initial surgery and implan- have not only failed to respond to conservative treatments tation. Another notable observation was that the extent of but also diagnosed with osteoarthritis of the PIP joint. The proliferative, inflammatory synovitis, and the foreign debris researchers employed various clinical assessments, such as in the multinucleated cells correlated with the time between pain scores, range of motion, and patient satisfaction. Regarding the results of the study, the researchers reported the first surgery and the beginning of the research [51]. The silicon microparticles were evidence of continued degenera- that the level of pain was markedly lower during 18-month tion and erosion, and they were linked to the intense follow-up. Particularly, the decline was from a high of 7.2 particulate-tissue reaction that is referred to as metallosis prior to the operation to 0.4 after the operation [65]. Con- [53–57]. Other researchers report of symptomatic titanium cerning patient satisfaction, on the other hand, respondents returned a score of 4.8 on a five-point Likert scale, with the debris and metallosis from other joint arthroplasty surgeries, such as elbow procedures [58–62]. In evaluating pathology in majority of the individuals indicating that they would repeat bone formation and joint function, researchers focus on the the procedure [65]. However, despite these positive indica- presence of metal debris with an intense tissue reaction that tors, the researchers note that some fractures were reported also features fibrosis and giant cells [63]. Silicone implants between one and two years after surgery; moreover, some deformity was notable in the coronal plane, and the flexion are linked to various debilitating effects attributed to tissue Applied Bionics and Biomechanics 5 30° 90° Figure 4: NeuFlex silicone finger joint with the different motion angles. one implant fracture was observed at a 4-year follow-up. Over- all, the silicone dorsal approach is the most preferred tech- nique by surgeons owing to the relative ease with which the procedure can be conducted among other advantages. Figure 5: Avanta finger silicone implant. The last silicone implant technique is referred to as sili- cone with lateral approach. Various studies have tested the contracture also declined from 18 degrees in some patients to efficacy of this approach [80–82]. Similar to the volar 0 degrees [65]. Overall, while the silicon and volar approach approach, the lateral approach also has its merits; however, has been reported to result in high rates of patient satisfac- the primary advantage of this technique is the ability to tion, reduced pain, and sustained range of motion, some preserve both the flexor and extensor tendons [70]. The patients reported deformity and severely declined flexion approach involves making a longitudinal skin incision on contracture. the lateral region of the proximal phalanx, which is then Apart from the silicone with volar approach, implants curved dorsally over the central phalanx [70]. After the sur- feature silicone with the dorsal approach. This technique is geon cuts the transverse fibers of the underlying retinacular the most frequently deployed model by medical surgeons, ligament, they lift the extensor apparatus, and they dislocate and it involves either a v-shaped tenotomy or a longitudinal the tendon laterally to remain with the bony insertion of its extensor tendon-split that may be performed while preserv- central band [70]. The surgeon lifts the ligament complex ing the central band insertion [70, 71]. Various studies have in one triangular flap before they proceed to reflect it proxi- tested the efficacy of this approach with varying results [28, mally. The exercise involves making a V-shaped incision, 72–79]. With this model, a dorsal midline is made through ensuring that the cut’s longitudinal branch can fit perfectly the extensor tendon all the way to the central slip insertion into the dorsal margin of the collateral ligament [70]. The that is separated from the endpoint of the middle phalanx anterior-oblique branch divides the phalango-glenoidal liga- [70]. The surgeon lifts the distally placed extensor tendon ment from the collateral and supplementary collateral [70]. flap of the common extensor, which despite resulting in dis- To dislocate the joint laterally, the proximal insertion of location of the joint, it does not interfere with the central slip the dorsal capsule and the volar plate is released. The pivot insertion at the bottom of the middle phalanx [70]. Among point that enables this movement is the contralateral lateral the reasons why the dorsal approach is preferred by surgeons ligament complex [70]. In concluding the process, the sur- are the relative ease of the procedure, the possibility to pre- geon performs bone resectioning and reaming of the canals. serve collateral ligaments, access to the joint extensor muscles The actual implant of the pyro-carbon components follows, and tendons, and the ability of the surgeon to easily maneu- and the last step of the procedure involves reduction of the ver around articular surfaces while preparing implant canals joint and resuturing of the collateral ligament complex to [79]. In one study, involving this procedure, researchers merge it with the phalango-glenoidal component [70]. In sought to examine the outcomes of patients among whom one study, researchers examined the outcomes of lateral sur- the NeuFlex implant had been used for either a PIP or gical procedures for the PIP joint arthroplasty that had been MCP arthroplasty as a treatment of osteoarthritis [73]. The performed using silicone implants as a treatment approach researchers reported a significant gain in flexion and arc to degenerative osteoarthritis [80]. While the range of motion of between 61 and 65 degrees [73]. Similarly, the study motion in the preoperative period averaged at 38 , postoper- ° ° ° also reported a relatively low extension lag of 3 and 0 for the ative, the reported score was 68 [80]. The researchers con- MCP and PIP groups, respectively. While the overall rate of cluded that the procedure was not only minimally invasive satisfaction among patients in this study was 90 percent in but also effective since surgeons had sufficient exposure to the aftermath of the procedures, the scores slightly dropped the area being operated on. However, to improve lateral postsurgery to 88 and 87 for the MCP and PIP groups, respec- stability, patients’ contralateral ligaments needed to be tively [73]. However, the researchers also acknowledge that reinforced. 6 Applied Bionics and Biomechanics 4. Metal Implant Arthroplasty Biomaterials are classified into five major groups, including ceramics, composites, metals, polymers, and materials of bio- logical origin. However, other classification systems differen- tiate biomaterials on other bases, including inertness and smoothness of surface inertness and degree of porosity, chemical reactivity, and bioabsorbability [83]. These mate- rials have usage in joint replacement therapy with variable results. In clinical usage, metallic material can belong to either the first or second classification system. Different metals, such as cobalt-chrome or stainless steel, react in vary- ing ways with body tissues. The efficacy of a given type of metal in arthroplasty is a function of the ability to withstand or endure the surrounding biological conditions. With some metals, such as titanium, the oxide layer that covers their sur- face makes it possible for them to be in direct contact with the surrounding biological context without raising the risk of detrimental chemical reactions. This feature of titanium Figure 6: MatOrtho PIP finger joint replacement. and related metals is referred to as bioinertness. In bioengi- neering, surgeons are always weary of materials with chemi- cally reactive surfaces which have the potential to provoke goal of retaining the natural collateral ligaments, which tissue response that can lead to direct bonding to bone or would serve to provide the required stability and natural osteoid [83]. A case in point is calcium phosphate, contained functions. In a later study, researchers significantly improved in glass ceramics, hydroxyapatite, and bioglass. The problem the degree of osseointegration through a thermal titanium with bioabsorbable materials, on the other hand, is that they spray on the surface of the proximal component stem. Cur- are prone to degradation, meaning, with time, they are rently, this implant is being offered as PIP surface replace- replaced by regenerating tissue either in part or fully. ment arthroplasty (SRA) [7, 85]. Newer approaches have In medical practice, bioengineers have selected several since replaced hydroxyapatite-coated cobalt chrome bearing suitable metals. The most commonly deployed metals in on UHMWPE or pyrocarbon [9]. Some of the PIP implants medical practice, for this matter, comprise cobalt chrome, have been cemented and others not but coated with the titanium, and several of its alloys, gold, tantalum, surgical hydroxyapatite to allow bone integration [86]. These cemen- stainless steel, and mercury-based alloys [83]. Metals can be ted implants were facing problems such as pain, stiffness, and classified as either light or heavy, and this weight is a major loosening [86, 87]. A cementless cobalt-chromium metal issue in biological implants; hence, bioengineers have set against polyethylene prosthesis is coated with hydroxyapatite the limit of metal density for material that can be used in to accelerate bone integration called MatOrtho proximal implants at 5 g/cm . The lightest metals include aluminum interphalangeal (Mole Business Park, Leatherhead, UK), as and titanium, meaning the rest of the metals mentioned shown in Figure 6 [88]. The results if implanting cementless above comprise heavy metals. The least reactive type of metal against polymer finger joint could lead to problems such metals comprises those that occur as pure elements in nature. as pain, loosening, stiffness, instability, dislocated polyethylene Another notable feature regarding metals is that the majority insert, and dissociation of the whole implant [86, 88]. of these compounds have alloys, which reduce their purity. More important, such impurities significantly determine 4.1. Pyrocarbon Implant Arthroplasty. Pyrocarbon, according to researchers, is increasingly strong due to a synthetically both the physical and chemical properties of metals. Various aspects of metals, including weight, purity, and chemical coated graphite core. The core is formed by heating a hydro- reactivity, are considered prior to the selection of the best carbon gas to extremely high temperatures [9]. These com- alternative for use as implants. pounds are a form of pyrolytic carbon, and they appear as Bioengineering research relating to the use of metals in ceramic material [89]. Regarding pyrocarbon implants, the Ontario Medical Advisory Secretariat notes that the compo- finger joint arthroplasty began at the end of the 70s. Linsc- heid and Dobyns are credited with pioneering a novel design nents comprise a pyrolytic carbon coating measuring 0.42 in which they experimented with a cobalt chrome proximal mm in thickness over an appropriately shaped graphite sub- component and high molecular weight polyethylene strate. For improved joint connection, the implant features (HMWPE) [84]. These researchers felt that available options ball and socket articulates, which have stems that come in the shape of the corresponding bones of the joint; hence, they for patients were limited; hence, they sought to resolve some of the issues associated with previous researcher’s proposals. can be inserted without bone cement [89]. Concerning the Among these issues was the lack of stability and poor physi- regulatory status of pyrocarbon finger joint implants, the ological articulation, an increased laterally directed stress. To United States Food and Drug Administration first approved achieve their mission, the researchers continuously sought to the Ascension MCP in 2002, as shown in Figure 7, but the product was already in use in Europe following its earlier find ways of minimizing bony resection of the joints with the Applied Bionics and Biomechanics 7 Figure 7: The ascension MCP. approval in 1999. The second pyrocarbon, Ascension PIP, 6. MCP Joint Surface Replacement which was developed by Ascension Orthopedics Inc., also The MCP is a ball and socket joint that appears as a convex received approval in 2002, but USFDA directed that the use shape on the metacarpal head. The joint is surrounded by of the components be limited to humanitarian. The Swanson collateral ligaments. Rheumatoid arthritis patients usually implant remains the most commonly used finger joint require MCP replacement, and the procedure includes silas- implant. tic interpositional replacement and rebalancing of the under- lying soft tissue. Before a patient can be considered for this procedure, the surgeon must conduct a preoperative assess- 5. PIP Joint Surface Replacement ment. More importantly, the approach is usually applied in cases of osteo- and posttraumatic arthritis, and individuals The proximal interphalangeal joint plays a major role in the must have adequate soft tissue and sufficient underlying liga- kinetic chain. This joint is attributed to approximately 40 ments. For individuals with rheumatoid arthritis, the inci- percent of the total range of active motions [9, 84, 90–92]. dence of soft-tissue imbalance might be severe; hence, the The joint helps individuals to grab smaller things and to hold surgeon needs to determine whether correcting ulnar devia- objects with an irregular shape. The fixed center of the PIP tions and palmar subluxation deformities is possible. In other joint’s rotation falls at the proximal insertion of the collateral words, the physician needs to assess whether the joint will ligaments, whereby, according to Singh and Dias, at different remain intact after the procedure has been performed. The joint positions, the tension in the collateral ligaments does success rate of these procedures is reported to be increasingly not change. Destruction of this joint is usually attributed to high, with some studies reporting one revision out of 13 inflammation or degeneration [5]. With a finger tourniquet, joints five years postoperation [99]. In this study, the the surgical technique for a PIP joint surface replacement researchers developed an unconstrained surface MCP joint can be performed while a patient is under local anesthesia replacement with a polyethylene and metacarpal phalangeal [9]. With this procedure, the joint is essentially approached material, which were attached to uncemented finned dorsally, longitudinally, or laterally. Singh and Dias note that polyethylene plugs to generate some level of motion in the a longitudinal split of the extensor tendon is preferable [9]. components [99]. Apart from the aforementioned complica- Under this approach, the incision is made to the attachment tions, the researchers also observed that out of the 13 joints, of the central slip, with the aim of detaching it from the liga- two exhibited lucency in the area of the phalangeal compo- ments in the middle phalanx to access the underlying soft tis- nent, while one exhibited some degradation in the metacar- sue. A number of complications are reported with this pal component [99]. Subluxation of the unconstrained approach associated with anatomical alignment, tendon component was also reported by other researchers [100– repair, and careful balance of soft tissue [93–98]. More- 103]. Like is the case with PIP joint surface replacement over, Singh and Dias report that pyrocarbon implants have arthroplasty, MCP joint surface replacement arthroplasty been noted to result in squeaks, and surgeons need to has varying success rates since some patients are reported inform patients prior to conducting the procedure. Among to experience dislocations of unconstrained implants. the reasons why patients who undergo PIP pyrocarbion arthroplasty require revision surgery are poorly selected cases or inclusion of patients who do not fit the criteria, 7. Autologous Small Joint Arthroplasty poor surgical procedures, the use of inappropriate pros- thetic material, and poorly designed prosthetic components Compatibility has been a major concern when it comes to [9]. Overall, since patients who undergo PIP joint replace- PIP and MCP joint arthroplasty. In a response to the result- ment with pyracarbons are prone to various complications, ing challenge of noncompatible components that react with they should be monitored closely both in pre- and postop- the surrounding tissue, resulting in degradation, pain, and erative periods. reduced postoperation motion, researchers sought to find Singh and Dias note that, with PIP surface implants, an alternative approach to treatment [104–107]. Autologous physicians are increasingly concerned about the range of small joint arthroplasty specifically focused on developing a progressive loss that patients are likely to experience as the technique that was not only biocompatible but also provided implants settle. patients with potential immediate vascularity and possible 8 Applied Bionics and Biomechanics future growth. Goebell is credited for experimenting with the [3] L. W. Catalano Iii, A. C. Skarparis, S. Z. Glickel, O. A. Barron, D. Malley, and L. B. Lane, “Treatment of chronic, first free-nonvascularized autologous joint transfer in 1913 traumatic hyperextension deformities of the proximal inter- [108]. However, the procedure has limited application in phalangeal joint with flexor digitorum superficialis tenod- modern practice, which is attributed to articular cartilage esis,” The Journal of hand surgery, vol. 28, no. 3, pp. 448– necrosis [109]. In 1967, researchers attempted to perform a 452, 2003. vascularized joint transfer [110]. In the mid-seventies, a [4] N. M. Vranis, B. Marascalchi, and E. Melamed, “Trends in study reported the first successful free toe joint transfer proximal interphalangeal and metacarpophalangeal joint [111]. Studies that followed the initial research have reported arthroplasty utilization using statewide databases,” The Jour- joint space preservation and maintenance of the hyaline car- nal of Hand Surgery (Asian-Pacific Volume), vol. 25, no. 1, tilage [112–125]. Tsai et al. studied both autogenous vascu- pp. 39–46, 2020. larized and nonvascularized total joint transfers in the [5] D. Herren, “The proximal interphalangeal joint: arthritis and hands of Macaca fascicularis monkeys among whom second deformity,” EFORT open reviews, vol. 4, no. 6, pp. 254–262, toe PIP joints were transferred as grafts to the hand, while the excised finger joints were relocated to the foot as nonvascu- [6] S. Kamnerdnakta, H. E. Huetteman, and K. C. Chung, “Com- larized free grafts [112]. Postoperative exams were con- plications of proximal interphalangeal joint injuries: preven- ducted at 16 weeks to ten months, and the researchers tion and treatment,” Hand clinics, vol. 34, no. 2, pp. 267– report that due to necrosis and infection two of the nonvas- 288, 2018. cularized grafts had to be amputated. In a similar study, in [7] J. M. Adkinson and K. C. Chung, “Advances in small joint which researchers sought to gain joint stability, stress toler- arthroplasty of the hand,” Plastic and reconstructive surgery, ance, painless function range of motion, and growth vol. 134, no. 6, pp. 1260–1268, 2014. potential through free vascularized digital joint transfers, [8] A. Naylor, S. C. Talwalkar, I. A. Trail, and T. J. Joyce, “In vitro researchers reported that six out of the seven procedures wear testing of a CoCr-UHMWPE finger prosthesis with were successful [113]. hydroxyapatite coated CoCr stems,” Lubricants, vol. 3, no. 2, pp. 244–255, 2015. 8. Conclusion [9] H. Singh and J. J. Dias, “Surface replacement arthroplasty of the proximal interphalangeal and metacarpophalangeal PIP and MCP joint therapy in artificial finger joints have joints: the current state,” Indian journal of plastic surgery, come a long way from the time when amputation and vol. 44, no. 2, pp. 317–326, 2011. arthrodesis were the only options; however, even modern [10] J. J. Hage, “History off-hand: Bunnell’s no-man’s land,” The techniques still face problems related to reactive tissues, Hand, vol. 14, no. 4, pp. 570–574, 2019. reduced range of motion, and flexion and extension deficits. [11] W. L. Newmeyer III, “Joseph H. Boyes, MD, 1905–1995: a Swanson silicone implants remain popular, and physicians driving force in American hand surgery,” The Journal of hand prefer silicone with the dorsal approach during operation. surgery, vol. 30, no. 3, pp. 436–440, 2005. However, other approaches, particularly the pyrocarbon [12] J. H. Boyes, “Bunnell's surgery of the hand,” American Jour- implant arthroplasty, have also attracted the attention of nal of Physical Medicine & Rehabilitation, vol. 50, no. 6, practitioners. The least favored technique is the autologous p. 309, 1971. small joint arthroplasty. Future studies need to find ways of [13] M. L. Drake and K. A. Segalman, “Complications of small merging the increased range of motion associated with pyro- joint arthroplasty,” Hand Clinics, vol. 26, no. 2, pp. 205– carbon and silicone implants with the element of retained 212, 2010. vascularity associated with autologous small joint arthro- [14] I. Gibson, S. P. Chow, K. W. Lam et al., “The Development of plasty. The challenge that exists concerns problems of an Artificial Finger Joint,” in Bio-materials and prototyping applications in medicine, pp. 157–190, Springer, Boston, infections and articular cartilage necrosis associated with MA, 2008. attempted retention of vascularity. [15] R. E. Carroll and T. H. Taber, “Digital arthroplasty of the proximal interphalangeal joint,” JBJS, vol. 36, no. 5, Data Availability pp. 912–920, 1954. The data used to support the findings of this study are [16] J.-H. Song, J.-Y. Lee, Y.-G. Chung, and I.-J. Park, “Distal included within the article. interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses,” Archives of orthopaedic and trauma surgery, vol. 132, no. 5, pp. 663– Conflicts of Interest 669, 2012. The authors declare that they have no conflicts of interest. [17] G. Mantovani, W. Y. Fukushima, A. B. Cho, M. A. Aita, W. Lino Jr., and F. N. Faria, “Alternative to the distal inter- phalangeal joint arthrodesis: lateral approach and plate fixa- References tion,” The Journal of hand surgery, vol. 33, no. 1, pp. 31–34, [1] R. A. Berger, “A brief history of finger arthroplasty,” The Iowa 2008. Orthopaedic Journal, vol. 9, p. 77, 1989. [18] F. Villani, B. Uribe-Echevarria, and L. Vaienti, “Distal inter- [2] G. Yang, E. P. McGlinn, and K. C. Chung, “Management of phalangeal joint arthrodesis for degenerative osteoarthritis the stifffinger: evidence and outcomes,” Clinics in plastic sur- with compression screw: results in 102 digits,” The Journal gery, vol. 41, no. 3, pp. 501–512, 2014. of hand surgery, vol. 37, no. 7, pp. 1330–1334, 2012. Applied Bionics and Biomechanics 9 [19] O. Aliu, D. T. Netscher, and M. Peltier, “Failure of small joint [38] A. Swanson and G. Swanson, Eds., “Flexible implant arthro- arthrodesis from resorption around a compression screw in a plasty of the radiocarpal joint,” Seminars in arthroplasty, patient with lupus-associated arthritis mutilans: case report,” 1991. The Hand, vol. 3, no. 1, pp. 72–75, 2008. [39] A. B. Swanson, S. G. de Groot, and B. K. Maupin, “Flexible implant arthroplasty of the radiocarpal joint surgical tech- [20] M. S. Burman, “Vitallium cup arthroplasty of metacarpopha- langeal and interphalangeal joints of fingers,” Bulletin of the nique and long-term study,” Clinical Orthopaedics and Related Research, vol. 187, pp. 94–106, 1984. Hospital for Joint Diseases, vol. 1, pp. 79–89, 1940. [40] M. I. Rossello, M. Costa, and V. Pizzorno, “Experience of [21] P. Hernigou, “Smith–Petersen and early development of hip total wrist arthroplasty with silastic implants plus grommets,” arthroplasty,” International Orthopaedics, vol. 38, no. 1, Clinical orthopaedics and related research, vol. 342, pp. 64–70, pp. 193–198, 2014. [22] F. L. Liebolt, “The use of capsulectomy and arthroplasty for [41] R. A. Capone, “The titanium grommet in flexible implant limitation of finger motion,” Plastic and Reconstructive Sur- arthroplasty of the radiocarpal joint: a long-term review of gery, vol. 6, no. 1, p. 93, 1950. 44 cases,” Plastic and reconstructive surgery, vol. 96, no. 3, [23] E. W. Brannon and G. Klein, “Experiences with a finger-joint pp. 667–672, 1995. prosthesis,” Plastic and Reconstructive Surgery, vol. 24, no. 2, [42] A. B. Swanson, “Flexible implant arthroplasty for arthritic p. 224, 1959. finger joints,” Plastic and Reconstructive Surgery, vol. 51, [24] A. E. Flatt, “Restoration of rheumatoid finger-joint function,” no. 1, p. 105, 1973. JBJS, vol. 43, no. 5, pp. 753–774, 1961. [43] A. Swanson and G. de Groot Swanson, “Flexible implant [25] K. Vainio, “Vainio arthroplasty of the metacarpophalangeal arthroplasty in the rheumatoid metacarpophalangeal joint,” joints in rheumatoid arthritis,” Journal of Hand Surgery, Clinics in rheumatic diseases, vol. 10, no. 3, pp. 609–629, 1984. vol. 14, no. 2, pp. 367-368, 1989. [44] T. E. Gillespie, A. E. Flatt, Y. Youm, and B. L. Sprague, “Bio- [26] J. W. Tupper, “The metacarpophalangeal volar plate arthro- mechanical evaluation of metacarpophalangeal joint prosthe- plasty,” Journal of Hand Surgery, vol. 14, no. 2, pp. 371– sis designs,” Journal of Hand Surgery, vol. 4, no. 6, pp. 508– 375, 1989. 521, 1979. [27] A. B. Swanson, “Flexible implant resection arthroplasty,” The [45] H. Gellman, W. Stetson, R. H. Brumfield Jr., W. Costigan, Hand, vol. 4, no. 2, pp. 119–134, 1972. and S. H. Kuschner, “Silastic metacarpophalangeal joint [28] A. B. Swanson, “Silicone rubber implants for replacement of arthroplasty in patients with rheumatoid arthritis,” Clinical arthritic or destroyed joints in the hand,” Surgical Clinics of Orthopaedics and Related Research, vol. 342, pp. 16–21, 1997. North America, vol. 48, no. 5, pp. 1113–1127, 1968. [46] C. M. Jensen, M. E. Boeckstyns, and B. Kristiansen, “Silastic [29] A. Swanson, “Implant resection arthroplasty of the proximal arthroplasty in rheumatoid MCP-joints,” Acta Orthopaedica interphalangeal joint,” The Orthopedic clinics of North Amer- Scandinavica, vol. 57, no. 2, pp. 138–140, 1986. ica, vol. 4, no. 4, pp. 1007–1030, 1973. [47] A. Kay, J. Jeffs, and J. Scott, “Experience with silastic prosthe- [30] A. Swanson, “Finger joint replacement by silicone rubber ses in the rheumatoid hand. A 5-year follow-up,” Annals of implants and the concept of implant fixation by encapsula- the Rheumatic Diseases, vol. 37, no. 3, pp. 255–258, 1978. tion,” Annals of the rheumatic diseases, vol. 28, Suppl 5, [48] B. Weightman, S. Simon, R. Rose, I. Paul, and E. Radin, p. 47, 1969. “Environmental fatigue testing of silastic finger joint prosthe- [31] S. Takigawa, S. Meletiou, M. Sauerbier, and W. P. Cooney, ses,” Journal of Biomedical Materials Research, vol. 6, no. 4, “Long-term assessmentof swanson implant arthroplasty in pp. 15–24, 1972. the proximal interphalangeal joint of the hand,” The Journal [49] T. Joyce and A. Unsworth, “A literature review of" failures" of of hand surgery, vol. 29, no. 5, pp. 785–795, 2004. the Swanson finger prosthesis in the metacarpophalangeal [32] R. L. Linscheid, “Implant arthroplasty of the hand: retrospec- joint,” Hand surgery, vol. 7, no. 1, pp. 139–146, 2002. tive and prospective considerations,” The Journal of hand [50] R. Atkinson and R. Smith, “Silicone synovitis following sili- surgery, vol. 25, no. 5, pp. 796–816, 2000. cone implant arthroplasty,” Hand clinics, vol. 2, no. 2, [33] S. Braley, “The silicones as tools in biological engineering,” in pp. 291–299, 1986. Biomaterials, pp. 67–89, Springer, Boston, MA, 1965. [51] C. A. Peimer, J. Medige, B. S. Eckert, J. R. Wright, and C. S. Howard, “Reactive synovitis after silicone arthroplasty,” Jour- [34] A. Roberts, “Silicones and their application as implant mate- rials,” Bio-Medical Engineering, vol. 2, pp. 156–160, 1967. nal of Hand Surgery, vol. 11, no. 5, pp. 624–638, 1986. [52] D. E. Foliart, “Swanson silicone finger joint implants: a review [35] A. Swanson, B. Maupin, N. Gajjar, and G. de Groot Swanson, of the literature regarding long-term complications,” The “Flexible implant arthroplasty in the proximal interphalan- Journal of hand surgery, vol. 20, no. 3, pp. 445–449, 1995. geal joint of the hand,” Journal of Hand Surgery, vol. 10, no. 6, pp. 796–805, 1985. [53] C. Willis-Owen, G. Keene, and R. Oakeshott, “Early metallosis-related failure after total knee replacement: a [36] A. B. Swanson, S. G. de Groot, and H. Ishikawa, “Use of report of 15 cases,” The Journal of bone and joint surgery Brit- grommets for flexible implant resection arthroplasty of the ish volume, vol. 93, no. 2, pp. 205–209, 2011. metacarpophalangeal joint,” Clinical Orthopaedics and Related Research, vol. 342, pp. 22–33, 1997. [54] J. J. Jacobs, R. M. Urban, N. J. Hallab, A. K. Skipor, A. Fischer, and M. A. Wimmer, “Metal-on-metal bearing surfaces,” [37] K. Schmidt, R. Willburger, A. Ossowski, and R. Miehlke, JAAOS-Journal of the American Academy of Orthopaedic Sur- “The effect of the additional use of grommets in silicone geons, vol. 17, no. 2, pp. 69–76, 2009. implant arthroplasty of the metacarpophalangeal joints,” The Journal of Hand Surgery: British & European Volume, [55] B. Ollivere, C. Darrah, T. Barker, J. Nolan, and M. Porteous, vol. 24, no. 5, pp. 561–564, 1999. “Early clinical failure of the Birmingham metal-on-metal 10 Applied Bionics and Biomechanics [71] A. Chamay, “A distally based dorsal and triangular tendinous hip resurfacing is associated with metallosis and soft-tissue necrosis,” The Journal of bone and joint surgery British vol- flap for direct access to the proximal interphalangeal joint,” ume, vol. 91, no. 8, pp. 1025–1030, 2009. Annales de chirurgie de la main: organe officiel des societes de chirurgie de la main, vol. 7, no. 2, pp. 179–183, 1988. [56] R. M. Urban, J. J. Jacobs, M. J. Tomlinson, J. Gavrilovic, J. Black, and M. Peoc'h, “Dissemination of wear particles to [72] W. Daecke, B. Kaszap, A. Martini, F. Hagena, B. Rieck, and the liver, spleen, and abdominal lymph nodes of patients with M. Jung, “A prospective, randomized comparison of 3 types hip or knee replacement,” JBJS, vol. 82, no. 4, pp. 457–477, of proximal interphalangeal joint arthroplasty,” The Journal 2000. of hand surgery, vol. 37, no. 9, pp. 1770–1779.e3, 2012. [57] J. J. Jacobs and N. J. Hallab, “Loosening and osteolysis associ- [73] S. Namdari and A.-P. C. Weiss, “Anatomically neutral sili- ated with metal-on-metal bearings: a local effect of metal cone small joint arthroplasty for osteoarthritis,” The Journal hypersensitivity?,” JBJS, vol. 88, no. 6, pp. 1171-1172, 2006. of hand surgery, vol. 34, no. 2, pp. 292–300, 2009. [58] A. Asahina, H. Fujita, S. Fukuda et al., “Extensive skin pig- [74] D. B. Herren and B. R. Simmen, “Palmar approach in flexible mentation caused by deposits of metallic particles following implant arthroplasty of the proximal interphalangeal joint,” total elbow arthroplasty: metallosis or not?,” British Journal Clinical Orthopaedics and Related Research, vol. 371, of Dermatology, vol. 157, no. 5, pp. 1074–1076, 2007. pp. 131–135, 2000. [59] I. Degreef, R. Sciot, and L. De Smet, “Metallosis in revision [75] C. Mathoulin and A. Gilbert, “Arthroplasty of the proximal total elbow arthroplasty. Complications and staging method,” interphalangeal joint using the Sutter implant for traumatic Acta orthopaedica belgica, vol. 74, no. 6, p. 753, 2008. joint destruction,” Journal of Hand Surgery, vol. 24, no. 5, pp. 565–569, 1999. [60] C. Khoo, J. Davison, and M. Ali, “Tissue reaction to titanium debris following Swanson arthroplasty in the hand: a report [76] J. Silva, R. Schwanke, M. Vicente, and M. Fridman, “Arthro- of two cases,” Journal of Hand Surgery, vol. 29, no. 2, plasty with silicone implant in post traumatic lesions of the pp. 152–154, 2004. proximal interphalangeal joint,” Revista Brasileira de Ortope- dia, vol. 33, pp. 79–82, 1998. [61] A. S. Sayed-Noor and G. O. Sjödén, “Severe metallosis after total elbow arthroplasty—a case report,” The Hand, vol. 5, [77] B. Cesari and J.-Y. Alnot, “Proximal interphalangeal joint no. 1, pp. 86–89, 2010. implant arthroplasty for degenerative or post-traumatic arthristis,” MAIN-PARIS-, vol. 2, pp. 85–96, 1997. [62] K. V. Voellmicke, M. Bansal, and M. J. O'Malley, “Failed first metatarsophalangeal arthroplasty salvaged by hamstring [78] V. D. Pellegrini Jr. and R. I. Burton, “Osteoarthritis of the interposition arthroplasty: metallic debris from grommets,” proximal interphalangeal joint of the hand: arthroplasty or The American Journal of Orthopedics, vol. 37, no. 2, fusion?,” The Journal of hand surgery, vol. 15, no. 2, pp. E42–E45, 2008. pp. 194–209, 1990. [63] I. K. Choudhry, J. M. Wilson, and P. J. Stern, “Metallosis fol- [79] K. D. Bickel, “The dorsal approach to silicone implant arthro- lowing silicone metacarpophalangeal joint arthroplasties plasty of the proximal interphalangeal joint,” The Journal of with grommets: case report,” The Hand, vol. 7, no. 2, hand surgery, vol. 32, no. 6, pp. 909–913, 2007. pp. 207–209, 2012. [80] M. Merle, F. Villani, B. Lallemand, and L. Vaienti, “Proximal [64] T. Joyce and A. Unsworth, “NeuFlex metacarpophalangeal interphalangeal joint arthroplasty with silicone implants prostheses tested in vitro,” Proceedings of the Institution of (NeuFlex) by a lateral approach: a series of 51 cases,” Journal Mechanical Engineers, Part H: Journal of Engineering in Med- of Hand Surgery (European Volume), vol. 37, no. 1, pp. 50–55, icine, vol. 219, no. 2, pp. 105–110, 2005. 2012. [65] I. R. Proubasta, C. G. Lamas, L. Natera, and A. Millan, “Sili- [81] A. Stahlenbrecher and J. Hoch, “Proximal interphalangeal cone proximal interphalangeal joint arthroplasty for primary joint silicone arthroplasty–comparison of Swanson and Neu- osteoarthritis using a volar approach,” The Journal of hand Flex implants using a new evaluation score,” Handchirurgie, surgery, vol. 39, no. 6, pp. 1075–1081, 2014. Mikrochirurgie, plastische Chirurgie: Organ der Deutschspra- chigen Arbeitsgemeinschaft fur Handchirurgie: Organ der [66] M. Lautenbach, S. Kim, M. Berndsen, and A. Eisenschenk, Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie “The palmar approach for PIP-arthroplasty according to der Peripheren Nerven und Gefasse: Organ der V, vol. 41, Simmen: results after 8 years follow-up,” Journal of Orthopae- no. 3, p. 156, 2009. dic Science, vol. 19, no. 5, pp. 722–728, 2014. [82] J. J. Hage, E. P. Yoe, J. P. Zevering, and P. J. de Groot, “Prox- [67] S. Bouacida, C. Lazerges, B. Coulet, and M. Chammas, imal interphalangeal joint silicone arthroplasty for posttrau- “Arthroplastie interphalangienne proximale avec implants matic arthritis,” The Journal of hand surgery, vol. 24, no. 1, Neuflex : interet de la voie d'abord palmaire avec reeduca- pp. 73–77, 1999. tion precoce,” Chirurgie de la Main, vol. 33, no. 5, pp. 350– 355, 2014. [83] Y. T. Konttinen, I. Milošev, R. Trebše et al., “Metals for joint replacement,” in Joint Replacement Technology, P. A. Revell, [68] H. H. Lin, J. D. Wyrick, and P. J. Stern, “Proximal interpha- Ed., pp. 81–151, Woodhead Publishing, 2014. langeal joint silicone replacement arthroplasty: clinical results using an anterior approach,” The Journal of hand surgery, [84] R. Linscheid and J. Dobyns, Eds., “Total joint arthroplasty. The hand,” Mayo Clinic Proceedings, 1979. vol. 20, no. 1, pp. 123–132, 1995. [69] L. H. Schneider, Ed., “Proximal interphalangeal joint arthro- [85] R. L. Linscheid, P. M. Murray, M.-A. Vidal, and R. D. Becken- plasty: the volar approach,” Seminars in arthroplasty, 1991. baugh, “Development of a surface replacement arthroplasty for proximal interphalangeal joints,” The Journal of hand sur- [70] M. Ceruso, S. Pfanner, and C. Carulli, “Proximal interphalan- gery, vol. 22, no. 2, pp. 286–298, 1997. geal (PIP) joint replacements with pyrolytic carbon implants in the hand,” EFORT Open Reviews, vol. 2, no. 1, pp. 21–27, [86] B. R. Johnstone, M. Fitzgerald, K. R. Smith, and L. J. Currie, 2017. “Cemented versus uncemented surface replacement Applied Bionics and Biomechanics 11 mal interphalangeal and metacarpophalangeal joint replace- arthroplasty of the proximal interphalangeal joint with a mean 5-year follow-up,” The Journal of hand surgery, ments,” American Journal of Roentgenology, vol. 197, no. 5, vol. 33, no. 5, pp. 726–732, 2008. pp. 1177–1181, 2011. [87] C. D. Jennings and D. P. Livingstone, “Surface replacement [102] A. Nakanishi, K. Kawamura, S. Omokawa, T. Shimizu, and arthroplasty of the proximal interphalangeal joint using the Y. Tanaka, “Reconstruction of a metacarpal head defect due PIP-SRA implant: results, complications, and revisions,” to bite injury: two case reports,” Case Reports in Plastic Sur- The Journal of hand surgery, vol. 33, no. 9, pp. 1565. e1– gery and Hand Surgery, vol. 5, no. 1, pp. 62–67, 2018. 1565. e11, 2008. [103] D. R. Dickson, R. Badge, D. Nuttall et al., “Pyrocarbon meta- [88] O. Flannery, O. Harley, R. Badge, A. Birch, D. Nuttall, and carpophalangeal joint arthroplasty in noninflammatory I. Trail, “MatOrtho proximal interphalangeal joint arthro- arthritis: minimum 5-year follow-up,” The Journal of Hand plasty: minimum 2-year follow-up,” Journal of Hand Surgery Surgery, vol. 40, no. 10, pp. 1956–1962, 2015. (European Volume), vol. 41, no. 9, pp. 910–916, 2016. [104] D. Muder, O. Nilsson, and T. Vedung, “Reconstruction of fin- [89] Medical Advisory Secretariat, “Pyrocarbon finger joint ger joints using autologous rib perichondrium–an observa- implant: an evidence-based analysis,” Ontario health technol- tional study at a single centre with a median follow-up of 37 ogy assessment series, vol. 4, no. 6, pp. 1–31, 2004. years,” BMC Musculoskeletal Disorders, vol. 21, pp. 1–12, [90] P. W. Jordaan, D. McGuire, and M. W. Solomons, “Sur- face replacement proximal interphalangeal joint arthro- [105] H. J. Boulas, “Autograft replacement of small joint defects in plasty: a case series,” The Hand, vol. 14, no. 5, pp. 669– the hand,” Clinical Orthopaedics and Related Research, 674, 2019. vol. 327, pp. 63–71, 1996. [91] D. Beevers and B. Seedhom, “Metacarpophalangeal joint [106] H. Baltzer and S. L. Moran, “Joint replacement arthroplasty: prostheses: a review of past and current designs,” Proceedings is it ever indicated in PIP joint fracture-dislocations?,” in of the Institution of Mechanical Engineers, Part H: Journal of PIP Joint Fracture Dislocations, pp. 155–170, Springer, Engineering in Medicine, vol. 207, no. 4, pp. 195–206, 1993. 2016. [92] A. Watts, A. Hearnden, I. Trail, M. Hayton, D. Nuttall, and [107] J. I. Billig, J. S. Nasser, and K. C. Chung, “National prevalence J. Stanley, “Pyrocarbon proximal interphalangeal joint of complications and cost of small joint arthroplasty for hand arthroplasty: minimum two-year follow-up,” The Journal of osteoarthritis and post-traumatic arthritis,” The Journal of hand surgery, vol. 37, no. 5, pp. 882–888, 2012. Hand Surgery, vol. 45, no. 6, pp. 553.e1–553.e12, 2020. [93] K. C. Chung, A. N. Ram, and M. J. Shauver, “Outcomes of [108] A. B. Gill, “Transplantation of entire bones with their joint pyrolytic carbon arthroplasty for the proximal interphalan- surface: A. Bruce Gill MD (1876-1965). The 6th president geal joint,” Plastic and reconstructive surgery, vol. 123, no. 5, of the AAOS 1937,” Clinical orthopaedics and related pp. 1521–1532, 2009. research, vol. 466, no. 1, pp. 47–49, 2008. [94] S. Ono, M. J. Shauver, K. W. Chang, and K. C. Chung, “Out- [109] W. C. Graham, “Transplantation of joints to replace diseased comes of pyrolytic carbon arthroplasty for the proximal or damaged articulations in the hands,” The American Jour- interphalangeal joint at 44 months mean follow-up,” Plastic nal of Surgery, vol. 88, no. 1, pp. 136–141, 1954. and reconstructive surgery, vol. 129, no. 5, pp. 1139–1150, [110] H. Buncke Jr., A. Daniller, W. Schulz, R. Chase, and H. J. Buncke Jr., “The fate of autogenous whole joints transplanted [95] T. M. Sweets and P. J. Stern, “Pyrolytic carbon resurfacing by microvascular anastomoses,” Plastic and Reconstructive arthroplasty for osteoarthritis of the proximal interphalan- Surgery, vol. 39, no. 4, pp. 333–341, 1967. geal joint of the finger,” JBJS, vol. 93, no. 15, pp. 1417–1425, [111] G. Foucher, F. Van Genechten, M. Merle et al., “The transfer from toe in reconstructive surgery of the hand : about seventy [96] B. R. Branam, H. G. Tuttle, P. J. Stern, and L. Levin, “Resurfa- cases toe-to-hand transfers in reconstructive surgery of the cing arthroplasty versus silicone arthroplasty for proximal hand : experience with seventy-one cases (In French),” interphalangeal joint osteoarthritis,” The Journal of hand sur- Annales de chirurgie de la main: organe officiel des societes gery, vol. 32, no. 6, pp. 775–788, 2007. de chirurgie de la main, vol. 3, no. 2, pp. 124–138, 1984. [97] K. Chan, O. Ayeni, L. McKnight, T. A. Ignacy, F. Farrokhyar, [112] T.-M. Tsai, L. Ogden, S. H. Jaeger, and K. Okubo, “Experi- and A. Thoma, “Pyrocarbon versus silicone proximal inter- mental vascularized total joint autografts–a primate study,” phalangeal joint arthroplasty: a systematic review,” Plastic The Journal of Hand Surgery, vol. 7, no. 2, pp. 140–146, 1982. and reconstructive surgery, vol. 131, no. 1, pp. 114–124, 2013. [113] B. M. O'Brien, J. S. Gould, W. A. Morrison, R. C. Russell, [98] D. McGuire, C. White, S. Carter, and M. Solomons, “Pyrocar- A. M. MacLeod, and J. J. Pribaz, “Free vascularized small joint bon proximal interphalangeal joint arthroplasty: outcomes of transfer to the hand,” The Journal of Hand Surgery, vol. 9, a cohort study,” Journal of Hand Surgery (European Volume), no. 5, pp. 634–641, 1984. vol. 37, no. 6, pp. 490–496, 2012. [114] T.-M. Tsai and R. Singer, “Elective free vascularized double [99] D. Harris and J. Dias, “Five-year results of a new total replace- transfer of toe joint from second toe to proximal interphalan- ment prosthesis for the finger metacarpo-phalangeal joints,” geal joint of index finger: a case report,” The Journal of hand Journal of Hand Surgery, vol. 28, no. 5, pp. 432–438, 2003. surgery, vol. 9, no. 6, pp. 816–820, 1984. [100] M. A. Syed, A. Smith, and H. Benjamin-Laing, “Pyrocarbon [115] T. Tsai, R. Singer, E. Elliott, and H. Klein, “Immediate free implant fracture after metacarpophalangeal joint arthro- vascularized joint transfer from second toe to index finger plasty: an unusual cause for early revision,” Journal of Hand proximal interphalangeal joint: a case report,” Journal of Surgery (European Volume), vol. 35, no. 6, pp. 505-506, 2010. Hand Surgery, vol. 10, no. 1, pp. 85–89, 1985. [101] J. M. Petscavage, A. S. Ha, and F. S. Chew, “Arthroplasty of [116] C. Y. Y. Loh, C.-C. Hsu, C.-H. Lin et al., “Customizing exten- the hand: radiographic outcomes of pyrolytic carbon proxi- sor reconstruction in vascularized toe joint transfers to finger 12 Applied Bionics and Biomechanics proximal interphalangeal joints: a strategic approach for cor- recting extensor lag,” Plastic and Reconstructive Surgery, vol. 139, no. 4, pp. 915–922, 2017. [117] N. Tsubokawa, T. Yoshizu, and Y. Maki, “Long-term results of free vascularized second toe joint transfers to finger prox- imal interphalangeal joints,” The Journal of hand surgery, vol. 28, no. 3, pp. 443–447, 2003. [118] T.-M. Tsai, J. B. Jupiter, J. E. Kutz, and H. E. Kleinert, “Vas- cularized autogenous whole joint transfer in the hand–a clin- ical study,” Journal of Hand Surgery, vol. 7, no. 4, pp. 335– 342, 1982. [119] A. Berger and R. Hierner, “Long-term results after vascular- ized joint transfer for finger joint reconstruction,” in Innova- tions in Plastic and Aesthetic Surgery, pp. 95–103, Springer, [120] S. H.-T. Chen, F.-C. Wei, H.-C. Chen, V. R. Hentz, D. C. Chuang, and M.-C. Yeh, “Vascularized toe joint transfer to the hand,” Plastic and reconstructive surgery, vol. 98, no. 7, pp. 1275–1284, 1996. [121] L. Squitieri and K. C. Chung, “A systematic review of out- comes and complications of vascularized toe joint transfer, silicone arthroplasty, and PyroCarbon arthroplasty for post- traumatic joint reconstruction of the finger,” Plastic and reconstructive surgery, vol. 121, no. 5, pp. 1697–1707, 2008. [122] K. Kimori, Y. Ikuta, O. Ishida, M. Ichikawa, and O. Suzuki, “Free vascularized toe joint transfer to the hand. A technique for simultaneous reconstruction of the soft tissue,” Journal of Hand Surgery, vol. 26, no. 4, pp. 314–320, 2001. [123] C.-C. Hsu, C. Y. Y. Loh, D. Kao, S. L. Moran, and Y.-T. Lin, “The impact of transferred vascularized toe joint length on motion arc of reconstructed finger proximal interphalangeal joints: a cadaveric study,” Journal of Hand Surgery (European Volume), vol. 42, no. 8, pp. 789–793, 2017. [124] C.-H. Lin, P.-L. Tang, and C.-H. Lin, “Second toe extensor digitorum brevis provides a simultaneous abductorplasty to free vascularized metatarsophalangeal joint transfer for post- traumatic thumb composite metacarpophalangeal joint defect,” Journal of Trauma and Acute Care Surgery, vol. 66, no. 5, pp. 1374–1378, 2009. [125] M. Liu, J. Jia, and Z. Hou, “Clinical observation of traumatically-damaged joint after its repair with transplanta- tion of allogenic joint,” Zhongguo xiu fu chong jian wai ke za zhi= Zhongguo xiufu chongjian waike zazhi= Chinese journal of reparative and reconstructive surgery, vol. 21, no. 8, pp. 797–800, 2007.

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Applied Bionics and BiomechanicsHindawi Publishing Corporation

Published: Jun 4, 2021

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