Progressive Radiographic Reduction of a Grafted Costal Cartilaginous Component after Proximal Interphalangeal Joint Arthroplasty

Summary:

Costochondral autografting is a biological option for reconstruction of severely damaged digital joints, but long-term serial documentation of structural change in the grafted cartilaginous component is limited. We report a 63-year-old man who underwent proximal interphalangeal joint arthroplasty using autologous fifth and sixth costochondral grafts for posttraumatic osteoarthritis after a lawnmower injury, with complete resurfacing of the proximal phalangeal head and partial reconstruction of the middle phalangeal base. The patient was followed up for more than 10 years with serial plain radiographs, magnetic resonance imaging, and clinical assessment. The postoperative clinical course was favorable, with preserved joint motion and minimal pain at long-term follow-up. However, serial plain radiographs demonstrated progressive reduction in the radiographic thickness of the grafted cartilaginous component and reconstructed joint region over 10 years. Because screws extended into the cartilaginous component, hardware removal was performed as a prophylactic measure after shared decision-making. Thereafter, no further radiographic progression was observed. Magnetic resonance imaging obtained immediately after hardware removal and again at 18 months postremoval demonstrated preservation of the reconstructed cartilaginous layer without appreciable interval change in thickness. This case suggests that structural change in a grafted costal cartilaginous component may progress silently despite preserved clinical function, and that fixation violating the cartilaginous component may represent a technical pitfall requiring careful long-term imaging surveillance.