Denervation of the proximal interphalangeal joint: Results from 54 cases in 42 patients.

INTRODUCTION

Arthropathy of the proximal interphalangeal joint (PIP) is common. Joint denervation is a symptomatic treatment. It relieves pain by cutting the afferent nerve branches without altering joint biomechanics, and is indicated in painful arthropathy with conserved range of motion. The objective of this study was to evaluate clinical outcome in PIP denervation and the sustainability of results.

HYPOTHESIS: Denervation is an effective intervention in painful PIP arthropathy with functional range of motion, showing lasting benefit.

PATIENTS AND

METHODS

A single-center retrospective study included all patients with painful PIP arthropathy with functional range of motion treated by denervation between January 2005 and September 2018 and evaluated by an independent examiner. Joint stiffness was an exclusion criterion. 54 consecutive denervation procedures were performed in 42 patients (41 women, 1 man) with a mean age of 66.5 years (range, 44-78 years). There were 11 inflammatory and 43 degenerative arthropathies.

RESULTS

The 42 patients were evaluated in consultation or contacted by telephone, with a mean follow-up of 51 months (range, 4-168 months). Mean VAS pain score was 7.5/10 (range, 5-10) before the procedure and 1.1/10 (range, 0-8) at last follow-up. Patients considered their joint cured or improved in 78% of cases whatever the etiology (42 cases/54), and in 86% of cases of degenerative arthropathy (37 cases/43). 32 patients were satisfied or very satisfied with the intervention (76% of cases). Active range of motion was improved in 16 cases, unchanged in 33 and impaired in 5. There were 7 denervation failures, which led to surgical treatment by fusion (2 cases) or joint replacement (5 cases); 5 of these cases concerned arthropathy of inflammatory origin.

CONCLUSION

Denervation is an effective treatment for painful PIP osteoarthritis, providing lasting pain relief while conserving range of motion.

LEVEL OF EVIDENCE: IV; retrospective study.