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).

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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