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Research project: Clinical and bioengineering investigation into the predictors & effectiveness of proximal interphalangeal joint surgery for patient with hand arthritis

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The impact of hand osteoarthritis is significant yet compared to lower limb research few studies have targeted hand OA to explore the success of conservative and surgical intervention (Wilder et al 2006). The European League against Rheumatism EULAR (2006) recommended that identification of predictors for successful hand joint replacement are considered an international research priority. The National Institute for Clinical Excellence has supported the use of pyrocarbon proximal interphalangeal joint (PIPJ) implants (NICE Interventional Procedure 110) and identifies research into the predictors for joint replacement success as a main concern (NICE 2008). Long term follow up for this type of replacement has been recommended (Hobby et al 2008). This research aims to systematically review the available evidence using a standardised review tool to assess and report the immediate and long term functional effectiveness of PIPJ arthoplasty.

Relevance to national and international priorities for hand surgery and patient management

The impact of hand osteoarthritis is significant yet compared to lower limb research few studies have targeted hand OA to explore the success of conservative and surgical intervention (Wilder et al 2006). The European League against Rheumatism EULAR (2006) recommended that identification of predictors for successful hand joint replacement are considered an international research priority. The National Institute for Clinical Excellence has supported the use of pyrocarbon proximal interphalangeal joint (PIPJ) implants (NICE Interventional Procedure 110) and identifies research into the predictors for joint replacement success as a main concern (NICE 2008). Long term follow up for this type of replacement has been recommended (Hobby et al 2008).

Clinical importance of the proposed research

The small synovial interphalangeal joints of the hand are commonly affected in degenerative, post traumatic and idiopathic arthritis (Tubiana et al.1996). The PIPJ is very complex. The articular surface allows flexion and extension but also subtle sideways tilt and rotation. Movement at the joint is controlled directly by flexor digitorum superficialis and extensor digitorum communis, but also indirectly by a complex system of tendons and ligaments that traverse the joint (the lateral band, central slip and oblique retinacular ligament). Stability is provided by the contour of the joint and the robust collateral ligament and palmar plate.

Joint replacement surgery, using anatomically accurate implants gives variable results. Some patients have excellent early movement and function. Others have disappointing results. The variability is likely due to the discrepancy between the position of the implant and the excised joint.

This study aims to assess pre-operative and post- operative function and relate this to the precise position if the joint in relation to the surrounding ligaments and tendons.
This research aims to:

  • Assess the immediate and long term functional effectiveness of PIPJ arthoplasty
  • Identify the bioengineering, physiological and disease specific factors that may predict surgical outcome for PIPJ surgery
  • Proposed investigation: type of intervention

Funding will support two phases of research

Phase I will include a specific critical review of the literature and synthesis of previous published studies into the effectiveness of PIPJ surgery and identification of predictors of outcome for PIPJ replacement.

Critical review and synthesis of research literature will focus on surgery and management of patients with hand osteoarthritis. Extrapolation to other joint osteoarthritis surgery studies that have identified predictors of surgical outcome will also be included. A critical review of papers that define patient self-report, clinical and bioengineering outcomes following surgery will be carried out.

Project team

Dr J Adams, Senior Lecturer, Faculty of Health Sciences
Mr D Warwick, Consultant Orthopaedic Surgeon, Southampton University Hospitals Trust, Prof M Taylor, Professor of Bioengineering Science, School of Engineering Sciences Prof M Stokes, Professor of Neuromusculoskeletal Rehabilitation, Faculty of Health Sciences, Dr C Metcalf, RCUK Roberts Fellow, Faculty of Health Sciences
Prof N Arden, Professor of Rheumatology, Southampton University Hospitals Trust Research Fellow: Dr C Ryall, Faculty of Health Sciences

Project funder

Ascension Orthopedics USA

Associated research themes

Hand joint surgery
Health Technologies
Rheumatology
Musculoskeletal disorders

Muscoluskeletal project cluster

Related research groups

Active Living and Rehabilitation
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