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Finger Joint Replacement (DIP & PIP)
Finger joint replacement (arthroplasty) is a surgical option for painful arthritis of the small joints of the fingers. It involves replacing the damaged joint surfaces with an artificial prosthesis to relieve pain and preserve some joint movement. Two different finger joints can be replaced: the distal interphalangeal (DIP) joint nearest the fingertip, and the proximal interphalangeal (PIP) joint in the middle of the finger. The two joints have different indications and suitability, described separately below.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue
Day case or overnight
Day case
First post operative review
One week
Driving
Depending on which finger(s) and joint(s), between three to six weeks
Post Operative Hand Therapy
Recommended for a minimum of around 12 weeks after surgery, particularly to reduce the risk of joint stiffness
Splinting
Varies by joint and surgical technique – see Recovery & rehabilitation below for detail
Pain relief
Paracetamol +/- ibuprofen, may require strong medications
Return to repetitive & heavy loading
Dependent on which finger(s) and joint(s) but may be 6-8 weeks
Finger Joint Replacement (DIP & PIP)
Finger joint replacement is one treatment option for arthritis affecting the small joints of the fingers. Two different joints can be replaced: the distal interphalangeal (DIP) joint near the fingertip, and the proximal interphalangeal (PIP) joint in the middle of the finger. The suitability of joint replacement, and the type of prosthesis used, differs between these two joints and is discussed separately below.
Which joints does Dr Tomlinson replace?
Dr Tomlinson offers DIP and PIP joint replacement for finger arthritis. She does not currently offer joint replacement of the wrist or the thumb base (carpometacarpal, CMC) joint. For thumb base arthritis, trapeziectomy and suspension arthroplasty, or joint fusion, are offered instead, given the long-term success and efficacy of these procedures. CMC joint replacement may be offered in future once more detailed and long term follow-up data on their efficacy, indications and suitability in different patients is available.
Who is this procedure for?
DIP joint replacement
- People with painful osteoarthritis or post-traumatic arthritis of the DIP joint
- Selected patients assessed by Dr Tomlinson as suitable candidates, generally those with lower-demand use of the hand
- Not usually recommended for younger patients or those who use their hands for moderate to heavy work – joint fusion is typically preferred in these groups, and is the most commonly recommended treatment for DIP joint arthritis overall
- People seeking joint replacement of middle, ring or little fingers, not index fingers
PIP joint replacement
- People with painful osteoarthritis, rheumatoid arthritis or post-traumatic arthritis of the PIP joint
- Selected patients with an early post-traumatic joint injury, who may be suitable for a hemi-hamate (partial joint) replacement instead of a full joint replacement
What does the surgery involve?
DIP joint replacement
DIP joint replacement involves removing the damaged joint surfaces and inserting an artificial silicone prosthesis. Two surgical approaches are used: one involves dividing and later repairing the extensor tendon, which requires around 8 weeks of immobilisation afterwards; a newer technique avoids dividing the tendon, allowing earlier movement of the joint. Dr Tomlinson will advise which technique is appropriate for you.
PIP joint replacement
PIP joint replacement involves removing the damaged joint surfaces and inserting an artificial prosthesis, most commonly through a dorsal (back of finger) surgical approach. Dr Tomlinson uses a silicone implant. Because the surgery involves dividing and then repairing the extensor tendon the finger is protected in a splint for up to 12 weeks after surgery (weaned from around 6 weeks).
Alternatives to joint replacement (arthroplasty) surgery
DIP joint replacement
Non-surgical management under the guidance of a hand therapist is an alternative to PIP joint replacement or fusion surgery. Joint fusion (arthrodesis) is the most commonly recommended surgical alternative for DIP joint arthritis, particularly for younger patients and those with heavy or repetitive hand use. Fusion is often preferred over replacement for this joint because its small size makes a durable prosthesis and stable result more difficult to achieve.
PIP joint replacement
Non-surgical management under the guidance of a hand therapist and joint fusion (arthrodesis) are alternatives to PIP joint replacement. Joint fusion may also be used as a salvage procedure if a joint replacement fails.
Dr Tomlinson will discuss which option suits your specific situation at your consultation.
Frequently Asked Questions
Am I suitable for a DIP or PIP joint replacement?
This depends on which joint in your finger is affected and the underlying cause of your arthritis. Dr Tomlinson will assess your joint(s) and discuss which treatment or procedure is most appropriate for you.
Where will my surgery be done?
At The Avenue Hospital
How much time will I need to have away from work?
This depends on what your job involves and which joint is fused. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical – heavy lifting, manual labour or “on tools” – you’ll usually need longer. Dr Tomlinson will give you advice tailored to your job and joint at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for six weeks after the procedure.
When can I do a full day of administrative or desk work?
From 2-8 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during a general anaesthetic. In line with current ANZCA guidance, if you’re having a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
Will my finger be immobilised after surgery?
This depends on which joint is replaced and the surgical technique used. For DIP joint replacement using the tendon-repair technique, the finger is generally immobilised for around 8 weeks; a newer technique that avoids dividing the tendon allows earlier movement. For PIP joint replacement yes your finger will be temporarily immobilised, but you will also have post operative exercises to begin one week after surgery. Rehabilitation is a balance of immobilisation (rest) and movement (exercises).
Will I need to see a hand therapist afterwards?
Yes. Post-operative hand therapy is important for both DIP and PIP joint replacement, particularly to reduce the risk of joint stiffness. A minimum of around 12 weeks of therapy is generally recommended, with consistent exercise important for the best outcome.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
DIP joint replacement
Published series report an overall complication rate of around 5%, including:
- Cellulitis (skin infection)
- Osteomyelitis (bone infection), which may require conversion to joint fusion
- Side-to-side joint instability, which may require conversion to joint fusion
- Mallet-type deformity, which may require tendon-shortening surgery to correct
PIP joint replacement
Published series report the following, in addition to the general risks above:
- Joint infection, including skin infection (cellulitis) and bone infection (osteomyelitis)
- Joint instability
- Joint stiffness – surgery will not restore full movement to a stiff joint
- Around 23% of joints required further surgery, and around 13% required revision surgery, at an average of 15 months after the initial operation, in one published series
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
DIP joint replacement
First 48 hours
Keep your hand elevated for 72 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time.
First 1–2 weeks
Keep the dressing dry and intact until your post-operative review, and your hand elevated in a sling. Do not lift or grip objects with the treated hand. Your hand therapist will fit you with a thermoplastic splint and commence range of movement exercises.
8 weeks
If the tendon-repair technique is used, the finger is generally immobilised for around 8 weeks before mobilisation begins; a newer technique that avoids dividing the tendon allows earlier movement and is generally performed by Dr Tomlinson but is not possible in all patients.
Longer term
Published series (average 57 months' follow-up) report significantly improved pain, with the joint typically around 11° short of full straightening. Overall complication rate reported around 5%.
PIP joint replacement
First 48 hours
Keep your hand elevated for 72 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time.
First few weeks
Post-operative hand therapy begins in this period and you are fitted with a custom thermoplastic splint; a minimum of around 12 weeks of therapy is recommended to reduce the risk of joint stiffness, with scar massage and supervised motion.
3 months
Full recovery of strength and movement typically takes 3 to 6 months or more.
Longer term
Published series report a five-year prosthesis survival rate of around 70-87%.
Want to know more about Finger Joint Replacement?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.