We recommend that adults and children over 12 wear face masks when attending our clinic, but no longer provide masks to patients and carers. Videoconsultations are conducted via telehealth at our dedicated virtual clinic. We are experiencing high demand for appointments hence 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. If our surgeons assess that your condition (especially recent injuries) is best managed with hand therapy rather than surgery we may recommend that you see a qualified hand therapist (physiotherapist or occupational therapist) rather than schedule an appointment with our surgeons. Dr Tomlinson will cease to offer consultations and surgical services where a Medicare Rebatable Item Code does not apply from 1 July 2023. This includes injections for palmar hyperhidrosis. If you are eligible to get vaccinated and/or boosted, please do. so.

Proximal interphalangeal (PIP) joint replacement surgery

Created 02 June 2012, last modified 24 December 2013

PIPJarthritisfromRadiopaediaDOTorg 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.

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.

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