1272 Tension Band Wire vs Apex Intramedullary Fusion Device for Hand Proximal Interphalangeal Joint Arthrodesis

Abstract

Abstract Aim Tension band wiring (TBW) is a popular arthrodesis technique for arthritic hand proximal interphalangeal joints (PIPJs), however often patients struggle with prominent metalwork and require further surgery to remove wires. This study compares outcomes of PIPJ fusion using traditional TBW with the newer Apex intramedullary implant and examines its cost-effectiveness. Method A retrospective analysis of 50 PIPJ fusions was performed in 37 consecutive patients using either TBW or Apex implant at a single unit between January 2013 and March 2020. Clinical and radiographic pre- and post-operative records were reviewed by two independent surgeons. The primary outcome measure was successful fusion of the joint, and complications or further surgery recorded as secondary outcomes. Cost-benefit analysis was performed to determine overall cost of procedure and any subsequent treatments. Results The TBW and Apex groups were comparable as to age, gender, diagnoses, and comorbidities. 27 fusions were performed using TBW compared with 23 fusions using Apex implant. Both cohorts demonstrated 100% union rates. 10 fusions (37%) from TBW group required removal of symptomatic metalwork at a mean 14.7 (± 10.9) months compared to none in the Apex cohort. Conclusions PIPJ fusion using the Apex implant demonstrated equivalent fusion rates to TBW and no additional surgery to remove hardware was required. The Apex implant has an additional cost of £655 (plus loan charge) but given that 37% of TBWs required further removal of metalwork, overall, the Apex implant proved to be cost effective. This study supports the use of the Apex implant as a favourable alternative to TBW.