Melbourne Hand Surgery 

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Latest news: We request that you wear a mask when you attend our practice in person, and 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 hospital surgeries are now unrestricted and you no longer need to have a COVID test prior to hospital admission. 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.

Proximal interphalangeal (PIP) joint replacement surgery

PIPJarthritisfromRadiopaediaDOTorgPIP joint replacement (arthroplasty) can be performed using a

  • Swanson (silicone) joint replacement prosthesis
  • Pyrocarbon joint replacement prosthesis
  • Hemi-hamate [suitable for replacement of half the joint only, in selected early cases of joint injury after trauma]

Pyrocarbon replacements are most commonly performed for osteoarthritis or post-traumatic arthritis. Swanson (silicone) joint replacements are most commonly performed for rheumatoid arthritis.

Results

This surgery is generally effective at relieving arthritic pain in the affected joint and at maintaining movement. The surgery will not restore full movement (or near-full movement) to a stiff joint. For more detail see the "Literature" section below.

Complications

Possible complications include skin infection (cellulitis), bone infection (osteomyelitis), infection of the joint or prosthesis, joint instability, joint stiffness and pain. If the joint replacement fails the usual back-up or salvage treatment is a joint fusion (arthrodesis).

Post operative therapy regimens

Ascension Pyrocarbon PIP joint replacement (dorsal approach)

Literature

 A 2012 study examined the outcomes and complications of patients with PIP joint replacement at a minimum of 2 years of follow-up. The 97 joint replacement surgeries were performed on 72 patients for primary osteoarthritis in 43 patients (60%), posttraumatic arthritis in 14 (19%), rheumatoid arthritis in 9 (13%), and psoriatic arthritis in 6 (8%). Twenty three percent of the joints had repeat surgery without revision, and 13% had revision at an average stage of 15 months after the initial joint replacement. The average pain score was zero (no pain). The conclusion was: "The survival of pyrocarbon PIP joint arthroplasty was 85% (83 of 97) at 5 years of follow-up, with high patient satisfaction. Patients should be advised that the procedure achieves good relief of pain but does not improve range of motion." Reference: Watts AC, Hearnden AJ, Trail IA, Hayton MJ, Nuttall D, Stanley JK. Pyrocarbon Proximal interphalangeal Arthroplasty: Minimum Two-Year Follow-Up. J Hand Surg May 2012 Vol 37:5; p882-888.

 

 

FRACS

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