Proximal interphalangeal (PIP) joint replacement surgery
PIP 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.
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.
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
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.