Outcomes of Joint Arthrodesis in Patients With Systemic Sclerosis

Abstract

BackgroundSystemic sclerosis (scleroderma) is a chronic autoimmune connective tissue disorder that can lead to significant pain and functional limitations of the digits. This study assessed complications and reoperations after interphalangeal joint arthrodesis in patients with scleroderma. MethodsA retrospective review was performed of all patients who underwent digital joint arthrodesis of the proximal interphalangeal (PIP), distal interphalangeal (DIP), or thumb interphalangeal (IP) joints between September 1, 2006 and December 31, 2019 at an integrated health system comprising two Level I trauma centers and two community teaching hospitals. Six patients who underwent arthrodesis of 13 interphalangeal joints were included in the study. Patient demographics, comorbidities, surgical information, and postoperative outcomes were collected from the medical record. ResultsThirteen digits in six patients were treated with digital joint arthrodesis. Three patients had diffuse scleroderma and four patients were female. The majority of procedures were performed on the PIP joint with Kirshner wires (9 of 13). No patients experienced intra-operative complications. Three patients experienced post-operative complications including flexion deformity, discomfort, and cellulitis. In patients who had a primary arthrodesis, two of nine joints went on to nonunion. One patient who underwent arthrodesis of four PIP joints for failed PIP arthroplasties went on to nonunion of all four digits. Of the patients with complications and nonunion, three required reoperation. ConclusionsOur study suggests that arthrodesis is an acceptable treatment option for patients with joint deformities secondary to scleroderma; however, surgeons and patients should be aware of higher rates of complications. Level of EvidenceIII, Therapeutic