The Swanson silicone PIPJ implant has been extensively evaluated. Ashworth and colleagues [19] reported on PIPJ silicone implants at an average follow-up of 5.8 years. Pain was not present in 67%, and at 9 years, prosthesis survivorship was 81%. The average postoperative arc of motion was 29°, compared with an average preoperative arc of motion of 38°. There were few complications in this series. Similarly, Lin and coworkers [16] reported on 69 silicone PIPJ spacers (48 with primary or post-traumatic osteoarthritis) at a mean follow-up of 3.4 years. The postoperative range of motion was 46°, compared with 44° pre-operative. The average preoperative extension deficit was 17°, compared with 8° postoperative. Sixty-seven of the 69 patients were relieved of pain. There were 12 joints with complications in this series, including five implant fractures. Most surgeons do not advocate the use of silicone spacers in the index or long PIP joints of active individuals. This is because of the high potential pinch force loads seen at the index and long finger PIP joints (Fig. 9).

Initial results using the surface replacement PIPJ (SBI) were published by Linscheid and colleagues in 1997 [8]. In this study, 66 PIPJ surface replacement arthroplasties were performed, with the majority of digits having osteoarthritis. After a mean follow-up of 4.5 years, 32 joints had good results, 19 fair, and 25 poor. This series included results from earlier versions of the surface replacement design. Better results were obtained from arthroplasties performed through

Fig. 9. Silicone spacer failures at the PIPJ of the index and long in a 67-year-old female.

a dorsal approach than those performed through a lateral or palmar approach. Complications occurred in 19 of the 66 PIPJ arthroplasties, and included instability, ulnar deviation, swan-neck deformity, flexion contracture, tenodesis, and joint subluxation. Component loosening was not observed. Range of motion at follow-up averaged from —14° extension to 61° flexion. There was a 12° in flexion/extension arc compared with the preoperative status [8].

Published results are not available for the Saffar and the Digitos prosthetic devices. Cond-amine and colleagues [14] have reported the results of the DJOA3, which they consider a "third-generation" PIPJ prosthetic device (see Fig. 4). The study reported satisfactory function in 110 implanted prostheses, with only a 3% loosening rate; however, 80% of the patients in this series had been followed for less than 1 year.

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