Treatment of Symptomatic Distal Interphalangeal Joint Arthritis

Abstract

Objective/Hypothesis: Arthritis at the distal interphalangeal (DIP) joint often results in pain and deformity. Arthrodesis of the DIP joint is commonly performed for symptomatic arthritis that has not responded adequately to nonoperative treatment. Although a variety of techniques have been described for DIP joint arthrodesis, the end result is a motionless joint. DIP fusion also carries the risk of malunion, nonunion, and implant-related complications. We hypothesize that an alternative technique involving an open dorsal cheilectomy and DIP joint debridement would result in adequate pain relief and cosmesis, while preserving joint motion and avoiding the potential complications associated with DIP arthrodesis. We present our experience with 78 patients with symptomatic osteoarthritis of the DIP joint who underwent an open dorsal cheilectomy and debridement of the DIP joint. Materials and Methods: There were 70 women and 8 men with a mean age of 64 years (range, 52-74 years) at the time of the surgery. The dominant hand was involved in 59 patients. The most common fingers were the middle (36 patients) and index (33 patients). Preoperative radiographic assessment demonstrated Kellgren and Lawrence grade 3 osteoarthritis in 44 patients and grade 4 in 34 patients. In all patients, through a lazy “S” incision over the dorsal DIP joint, an arthrotomy was performed on each side of the extensor tendon and debridement of the joint was performed removing osteophytes from the DIP joint, while preserving the insertion of the extensor mechanism. At completion, the DIP joint was immobilized in an extension splint. At 4 weeks postoperatively, the splint was removed and physical therapy was initiated for active range of motion. At the final follow-up, pain level, satisfaction, and DIP joint range of motion were assessed. Results: The mean final follow-up was 37 months (range, 24-62 months). All clinical parameters demonstrated statistically significant improvement at final follow-up. Mean patient pain visual analogue scale scores improved from 8.3 preoperatively to 1.2 postoperatively. Patient satisfaction scores significantly improved by an average of 7 points. Mean flexion contracture of the DIP joint significantly improved from 11.4° preoperatively to 4.6° postoperatively. There were no postoperative infections or tendon rupture. Six patients experienced mild extensor tendon weakness at the DIP joint. No patients required additional surgery. No other complications were encountered. Conclusions: Open dorsal cheilectomy and debridement of the DIP joint in patients with symptomatic DIP joint osteoarthritis is a safe and reliable alternative procedure. This surgical technique reduces pain while preserving DIP joint motion.