Abstract
BackgroundThe aims of this study were to propose a novel implant design for the proximal interphalangeal joint (PIPJ) of the hand using a rolling contact joint (RCJ) mechanism and to derive an optimal implant design based on human PIPJ kinematics.MethodsIn total, 10 participants with normal PIPJs were enrolled in this study. True lateral finger radiographs were obtained in 10° increments from 0º (full extension) to 120° flexion of PIPJ. Radiographs were used to determine the average center of rotation, which formed the basis of a mathematical expression of the PIPJ kinematics. The variations in extensor tendon excursions in relation to the range of motion of PIPJ were determined using results from previous cadaveric studies. As the next step, a PIPJ implant design using an RCJ mechanism that was most consistent with the mathematically expressed PIPJ kinematics and tendon excursions was determined using a constrained optimization algorithm.ResultsThe final proposed PIPJ implant had a relatively constant center of rotation over the entire PIPJ range of motion among the participants. In addition, the extensor tendon excursions of the proposed implant as applied to the phalangeal bones were similar to those of the human tendon. The proposed PIPJ implant achieved an acceptable position of the RCJ surface on the proximal and middle phalanges, which was derived from the constrained optimization algorithm.ConclusionsA novel PIPJ implant design using an RCJ mechanism demonstrated acceptable outcomes in terms of PIPJ human kinematics and tendon excursions.
Highlights
Joint replacement arthroplasty of the proximal interphalangeal joint (PIPJ) can be performed as the salvage procedures when the joint is destroyed due to reasons such as degenerative arthritis, inflammatory arthritis, and post-traumatic arthritis [1]
Determination of the average center of rotation We hypothesized that the human PIPJ is a hinge joint with a 1 degree of freedom (1-DOF) of motion around the center of rotation in the sagittal plane, and we proposed an estimation method that gives the center of rotation of human PIPJ, i.e., average center of rotation (ACR), using plain radiographic data to explain the ideal human PIPJ kinematics
The rolling contact joint (RCJ) motion should be similar to the human PIPJ kinematics, and the extensor and flexor tendon excursion should be within acceptable magnitudes as compared to those of the human PIPJ [22]
Summary
Joint replacement arthroplasty of the proximal interphalangeal joint (PIPJ) can be performed as the salvage procedures when the joint is destroyed due to reasons such as degenerative arthritis, inflammatory arthritis, and post-traumatic arthritis [1]. Post-traumatic arthritis is a well-known complication of articular fracture associated with PIPJ dislocation, and total PIPJ replacement arthroplasty might be one of the best options for reducing the pain and range-of-motion limitation in Various implant designs for the PIPJ have been proposed in clinical practice. An optimal combination of designs and materials to provide durability and biocompatibility to the PIPJ implant has not yet been established [5]. The PIPJ implants that have been developed far are less durable and are able to achieve less improvement in the functional range of motion than hip or knee joint prostheses [6]. The aims of this study were to propose a novel implant design for the proximal interphalangeal joint (PIPJ) of the hand using a rolling contact joint (RCJ) mechanism and to derive an optimal implant design based on human PIPJ kinematics
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