Melbourne Hand Surgery 

Coronavirus update: We will be closed on Wednesday 8 April, but will reopen at 8:30am on Thursday 9 April. 

Melbourne Hand Surgery has mechanisms to protect our patients and staff while we continue to provide healthcare services. All consultations are now conducted via telehealth (phone or videoconference), except where we have previously confirmed the requirement for an in-person physical examination or wound care management.  Only emergency surgery is being conducted in hospitals for the foreseeable future, in keeping with Government directives. 

Due to the change in circumstances we will be closed on Fridays until further notice. If our practice is unable to physically open for business at any point in the coming weeks or months we will communicate this to existing scheduled patients via email and SMS (please do not attempt to reply other than with Y or N to an SMS, as the automated system does not facilitate this). Incoming telephone calls and receipt of voicemail messages may be temporarily affected by such a change. We will use this website banner to update you on changes to our practice and the availability of non-urgent procedures and surgery in the weeks and months ahead. Thank you for your understanding as our entire community works through these unprecedented and rapidly evolving times together (last updated: 4 April 2020).

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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