Melbourne Hand Surgery 

Coronavirus update: All suitable consultations at Melbourne Hand Surgery are currently conducted via telehealth (phone or video consultation) to maximise patient and staff safety. We have implemented enhanced hygiene meaures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. 

We are continuing to perform rooms procedures, including needle fasciotomies for Dupuytren's contracture. There are  currently restrictions on performing elective surgery in Victorian hospitals, as private hospitals are accommodating aged care residents as well as providing nursing staff for aged care residences. We are currently taking bookings for and scheduling emergency and category 1 surgeries at The Avenue and Epworth Freemasons. We are taking bookings for category 2 and 3 surgeries from 21 September, or as soon as the pandemic situation permits. Please note that all patients who are scheduled for elective surgery admission are required to undertake a COVID test and obtain a negative ("not infected") result prior to admission. 

Victorians are in this together and together we will get through this. Thank you for your understanding as our community works through these unprecedented times together (last updated: 3 August 2020).

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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