Twenty-Year Outcomes After Hemi-Hamate Resurfacing Arthroplasty of the Proximal Interphalangeal Joint

BACKGROUND: Described in 1999, the hemi-hamate resurfacing arthroplasty (HHRA) is a reconstructive option for the treatment of dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint. Good short- and mid-term results have been reported, but only recently have long-term survivability data become available. This study evaluates long-term patient-reported and radiographic outcomes after HHRA. METHODS: Patients known to have undergone HHRA at a single institution prior to 2010 were contacted via telephone following institutional board review approval. Those willing to participate were invited for an in-person office or virtual visit. Collected data included Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), numeric rating scale (NRS), and single assessment numeric evaluation (SANE) scores, finger motion, and radiographs of the finger and hand. RESULTS: A total of 13 patients were included at an average of 21.5 years (range, 16-28 years) after HHRA. Average age was 33 (range, 16-65 years) and 54 (range, 32-90 years) at the time of surgery and at data collection, respectively. Average active range of motion at the PIP joint measured 33 to 83 degrees. Numeric rating scale averaged 1.1 (0-2) and 0.3 (0-2) regarding the affected finger and hand, respectively; QuickDASH averaged 2.6 (0-13.6), and SANE averaged 80% (20%-100%). Eleven radiographic series were of acceptable quality for accurate interpretation. Proximal interphalangeal joint arthrosis was appreciable in all patients (11/11), the severity of which ranged from mild-moderate (5) to severe (6). One graft failure occurred after a secondary injury within the first year following reconstruction. No revision reconstructions or joint salvage procedures were performed. No static fourth/fifth carpometacarpal joint instability or arthritis was found. CONCLUSION: Joint arthrosis is observed in the PIP joint 2 decades after HHRA; however, this does not correlate with patient outcome scores, which are good to excellent. Joint stability and graft survivability are excellent at long-term follow-up. This 20-year outcome report supports the long-term success of the HHRA for the treatment of middle phalanx pilon fractures in the setting of dorsal fracture-dislocations.