Salvage of failed Swanson’s arthroplasty of the distal interphalangeal joint

Dear Editor, Silicone  interposition arthroplasty may provide pain relief for patients with  distal interphalangeal joint (DIPJ) arthritis who wish to preserve joint  movement (Neukom et al., 2020), with reported failure rates ranging from 4.7% to 9.6% (Sierakowski et al., 2012).  Conversion to arthrodesis after failed DIPJ arthroplasty has been  reported in 5% to 13% of patients. There is no established technique for  DIPJ arthrodesis in such cases (Neukom et al., 2020; Sierakowski et al., 2012). We present our approach and the results in six patients. Access to the DIPJ is achieved using a dorsal H-shaped incision (Figure 1).  Preparation of the middle and distal phalangeal canals using a Mitchell  trimmer (Orthocare, Shipley, UK) provides healthy bone for the  structural corticocancellous distal radial bone graft; this is harvested  from the distal radius via the third extensor compartment, preserving  the distal extensor retinaculum. The bone graft is designed as a block  with proximal and distal triangular extensions (Figure 1).  A 0.9 mm Kirschner wire is used to create multiple holes around the  marked bone graft, followed by completion using a sagittal bone saw. The  bone graft can be elevated using a Mitchell trimmer. Further cancellous  bone graft is then harvested. The proximal extension of the  corticocancellous bone graft is inserted into the middle phalanx, and  the distal phalanx is then distracted to facilitate insertion of the  distal extension; bony compression is achieved as the distal phalanx is  released. Fixation is achieved using an axial 1.0 mm Kirschner wire,  supplemented with a 0.4 mm cerclage wire loop with the ends folded down  onto the dorsum of the graft; this prevents cerclage wire protrusion (Figure 2).  Cancellous graft may then be packed over the dorsum of the structural  bone graft and the extensor tendon repaired to cover the cerclage wire  ends. The longitudinal Kirschner wire is cut below the surface of the  skin (Figure 2)...</p