SCIENTIFIC ARTICLE Revision Proximal Interphalangeal Arthroplasty: An Outcome Analysis of 75 Consecutive Cases Eric R. Wagner, MD, * T. David Luo, MD, * Matthew T. Houdek, MD, * Daryl J. Kor, MD,† Steven L. Moran, MD, * Marco Rizzo, MD* Purpose To examine the outcomes and complications associated with revision proximal interphalangeal (PIP) joint arthroplasty. Methods An analysis of 75 consecutive revision PIP joint arthroplasties in 49 patients, per- formed between 1998 to 2012, was performed. The mean age at the time of surgery was 58 years. Thirty-two patients had a history of prior PIP joint trauma, and 18 patients had rheumatoid arthritis. There were 12 constrained (silicone) implants and 63 nonconstrained implants (34 pyrocarbon and 29 metal-plastic). Results Over the 14-year period, 19 (25%) fingers underwent a second revision surgery. Second revision surgeries were performed for infection, instability, flexion contracture, and heterotopic ossification. The 2-, 5-, and 10-year survival rates were 80%, 70%, and 70%, respectively, for patients requiring a second revision for PIP joint arthroplasty. Worse outcomes were seen with postoperative dislocations, pyrocarbon implants, and when bone grafting was required. Two operations were complicated by intraoperative fractures, but neither required stabilization. Sixteen patients undergoing revision surgery experienced a postoperative complication, including 2 infections, 1 postoperative fracture, 3 cases of heterotopic ossification, and 10 PIP joint dislocations. The volar approach and the use of a pyrocarbon implant was associated with increased rates of heterotopic ossification, whereas preoperative instability increased the rates of PIP joint dislocation following revision. At a mean of 5.3 years (range, 2e10 years) follow- up, 98% of patients had good pain relief but decreased PIP joint total arc of motion. Conclusions Proximal interphalangeal joint arthroplasty in the revision setting represents a challenge for surgeons. Revision arthroplasty was associated with a 70% 5-year survival but with a high incidence of complications. Instability was associated with worse outcomes. In this series, silicone and metal-polyethylene implants had lower rates of implant failure and postoperative complications than ones made from pyrocarbon. (J Hand Surg Am. 2015;-(-):-e-. Copyright Ó 2015 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Prognostic III. Key words Proximal interphalangeal joint arthroplasty, revision surgery. P RIMARY PROXIMAL INTERPHALANGEAL (PIP) joint arthroplasty has been shown to be an effective treatment in the setting of advanced degen- erative changes of the PIP joint. PIP joint arthro- plasty preserves some motion and relieves pain with reasonable implant survival. 1e18 The reported revision rates after primary PIP joint arthroplasty are between 8% and 20%. 2e6,15,17e19 In addition to this relatively high revision rate, postoperative From the *Department of Orthopedic Surgery, Division of Hand Surgery; and the †Department of Anesthesiology, Mayo Clinic, Rochester, MN. Received for publication March 25, 2015; accepted in revised form May 20, 2015. S.L.M. is a consultant for Integra. Corresponding author: Marco Rizzo, MD, Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905; e-mail: rizzo.marco@ mayo.edu. 0363-5023/15/---0001$36.00/0 http://dx.doi.org/10.1016/j.jhsa.2015.05.015 Ó 2015 ASSH r Published by Elsevier, Inc. All rights reserved. r 1