Osteoarthritis Proximal Interphalangeal Joint Silastic Implants

Thomas Bienz and A. Lee Osterman

History and Clinical Presentation

This 66-year-old right hand dominant woman had a long history of osteoarthritis involving multiple joints of the hand, and knees. She initially presented in 1989 at age 51 with atraumatic, spontaneous onset of painless distal interphalangeal (DIP) joint arthritis and painful degeneration in the dominant hand's basal joint requiring ligament reconstruction and tendon interposition (LRTI) arthroplasty. This was followed by similar basal joint symptoms in the nondominant hand requiring arthroplasty 2 years later. Over the next 6 years, she developed progressive degeneration of the left knee as well as the proximal interphalangeal (PIP) and DIP joints of both hands. The left knee required arthroplasty in 1996, but activity modification and the use of nonsteroidal antiinflammatory drugs (NSAIDs) allowed her to avoid further hand surgery until 1999.

At that time, the right long finger PIP joint degeneration compounded by stenosing flexor tenosynovitis of the index and long fingers became sufficiently painful to warrant surgical intervention. The past medical history was additionally significant for hypertension, mild depression, bilateral carpal tunnel syndrome responsive to conservative management and prior cholecystectomy. Medications included Verelan, Lozol, Voltaren, and Prozac.

Physical Examination

The patient had significant degeneration of the PIP joints with osteophyte formation (Bouchard's nodes), and similar findings in the DIP joints (Heberden's nodes). Range of motion (ROM) was most limited in the DIP joints; however these joints did not cause her a great deal of pain (Table 67—1). The right long

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