Melbourne Hand Surgery 

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Latest news: Masks are mandatory when you attend our practice in person, and we request that you log your attendance via our Victorian Government QR code, by entering location code 3D7RE3 into the Services Victoria App or by writing your details on the physical register at our reception.

Elective surgeries are currently unrestricted and you do not need to have a COVID test prior to hospital admission for elective surgery if you have no COVID symptoms or other risk factors. Dr Tomlinson is operating at The Avenue and Glenferrie Private; Epworth Cliveden is indefinitely closed at this time. 

All suitable consultations at Melbourne Hand Surgery are currently conducted via telehealth at our dedicated virtual clinic to maximise patient and staff safety. We have implemented enhanced hygiene measures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. We require that all patients provide a referral prior to booking an appointment so that we can identify and manage urgent and emergency conditions in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation.

Articles

Distal interphalangeal joint (DIPJ) replacement

DIP joint arthroplasty can be performed for painful osteoarthritis and post-traumatic arthritis. Most commonly surgeons recommend joint fusion (arthrodesis) for painful, stiff osteoarthritis of the DIP joint, especially in younger patients and patients who use their hands for moderate or heavy work. Unfortunately due to the small size of the DIP joints it is difficult to obtain a good prosthesis and a stable result. Joint replacements are more likely to be performed with satisfactory results in the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints.

That said, in selected patients good results have been obtained with DIP joint replacement. Your surgeon can advise you whether you are suitable for this treatment and what the risks and benefits would be for you.

Literature

DIPJosteoarthritisfromRadiopaediaDOTorgA 2012 study reported on the results of Swanson replacement in 131 DIP joints for painful osteoarthritis or post-traumatic arthritis. Thirty-seven joints in 28 patients were done using a technique that cuts and then repairs the extensor tendon, which requires post operative immobilisation for 8 weeks. The following 94 joint replacements in 60 patients were done without cutting the tendon, so that joints could be mobilised immediately. Patients were assessed after an average of 57 months (4 and 3/4 years) and reported that their pain was significantly improved following surgery. The average range of joint movement was 39°, and patients were generally 11° off being able to fully straighten the joint. The overall complication rate was 5% (7 joints), with 3 instances of cellulitis and one instance of osteomyelitis (which required subsequent fusion). Two joints had subsequent fusions because of side-to-side joint instability. One patient had a persistent droop to the joint ('a mallet-type deformity'), which was corrected by tendon shortening.

Reference

Sierakowski A, Zweifel C, Sirotakova M, Sauerland S, Elliot D. Joint replacement in 131 painful osteoarthritis and post-traumatic distal interphalangeal joints. J Hand Surg Eur Vol May 2012 vol. 37 no. 4 304-309.

 

FRACS

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