Custom-Made Cement Spacer to Replace a PIP Infected Prosthesis: A Case Report and Review of Therapeutical Options

PURPOSE: Use of prosthesis to replace small hand joints, mainly in patients with de-generative osteoarthritis or with sequelae of fractures, is more and more common. As for other joints, use of prosthesis usually leads to good functional results, but is not free of complications such as implant infection. We discuss a possible solution presenting a single case treated by means of a custom-made spacer in our hospital comparing it to the very few options available in literature. METHODS: A 30-year-old active male, treated in another hospital two years before for an articular fracture of the middle phalanx of the ring finger of his left hand, came to our center with a rigid digit. He was therefore treated with a Swanson proximal interpha-langeal (PIP) joint prosthesis. At one month follow-up the patient presented clear infection signs of his implant. Authors removed the infected implant and replaced it with a small custom-made antibiotic impregnated cement spacer. The patient underwent a long lasting post-operative oral antibiotic therapy. Four months later a new Swanson prosthesis has been successfully implanted. Literature review has been performed. RESULTS: When the patient first came to our hospital, he presented with a rigid digit, reaching the day after our first surgery a PIP joint range of motion (ROM) in flex-ion-extension of 0-90°. At one-month follow-up, with the infected prosthesis, the ROM was 10-40°. After the last surgery, with the implant of a new Swanson prosthesis, at the six-month follow-up the patient was infection free, the PIP joint ROM was 10-90° and the patient was very satisfied. CONCLUSIONS: The literature discusses few cases of PIP prosthesis infection, and most of those are treated with implant removal and arthrodesis. The possibility of using a cus-tom-made antibiotic-impregnated cement spacer to achieve good results, as is universally accepted for other joints, should be kept in mind by all hand surgeons who face to prevent more drastic solutions.