Clinical outcomes of distraction (gap) arthroplasty as an alternative to arthrodesis for septic hand arthritis with osteomyelitis.

OBJECTIVE

Septic arthritis of the hand often leads to sti!ness or even complete loss of joint function. Septic arthritis with osteomyelitis is especially severe. In this case, most experts recognize the need to perform arthrodesis. This study is devoted to another way of solving this problem.

METHODS

The results of treatment of 240 patients (255 joints) treated for septic arthritis of the hand were retrospectively analyzed. In most cases, septic arthritis with osteomyelitis was noted-145 (56.9%). All patients were operated on. After resection of osteochondral structures, in most cases, the developed method named distraction (gap) arthroplasty was used. Mid-term results were assessed within 7 months (interquartile range [IQR]: 4-9). Finger function was assessed using the total active motion (TAM) system.

RESULTS

With the development of osteomyelitis, the delay in treatment was longer than in patients without osteomyelitis: 13 days (IQR: 4-22). Tendon destruction, which prevents the restoration of joint function, was observed in 12 (4.7%) cases. After rehabilitation, the maximum median TAM was in patients after arthritis with osteomyelitis of the metacarpophalangeal (MCP) joint-68.1% (IQR: 50.1-86.2), 65.3% (IQR: 49.4-75.4), 60.8% (IQR: 58.7-72.4), and 63.8% (IQR: 51.7-71.9) after arthritis with osteomyelitis of the proximal interphalangeal (PIP) joint, distal interphalangeal (DIP) joint, and thumb interphalangeal (IP) joint, respectively.

CONCLUSION

Septic arthritis of the hand is a severe disease that is often accompanied by the development of osteomyelitis, the spread of a purulent process to the paraarticular soft tissues, and sometimes the destruction of the tendons. It often leads to the need for arthrodesis or amputation of the finger. As an alternative to this, a treatment method named "distraction (gap) arthroplasty" after resection of the a!ected structures of the joint can be considered.

LEVEL OF EVIDENCE: Level IV, Therapeutic Study.