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Substituição da articulação interfalângica proximal

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PIP joint replacement addresses painful arthritis in the middle finger joint when non-surgical options fail.

Updated May 2026
Uma ilustração desenhada à mão de um implante de substituição da articulação do dedo médio.
A articulação da DIP é a do meio das três articulações dos dedos. Uma substituição recobre a articulação com um implante, em vez de fundi-la completamente. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

Por que esta cirurgia foi sugerida

Seu cirurgião sugeriu uma artroplastia da articulação interfalângica proximal, frequentemente chamada de artroplastia da articulação PIP. Esta cirurgia substitui a articulação danificada do seu dedo por uma artificial para tratar a artrite por desgaste. Ela é geralmente oferecida quando as opções não cirúrgicas não proporcionaram alívio suficiente para a dor ou rigidez.

Esta cirurgia tem como objetivo proporcionar melhor mobilidade e estabilidade, ao mesmo tempo em que reduz a dor. É uma opção confiável para o dedo indicador, embora seja menos comum para o dedo médio. A maioria dos pacientes retorna ao trabalho após uma mediana de 8 semanas. Embora a infecção seja incomum, cerca de 1 em cada 5 pacientes podem precisar de cirurgia de revisão dentro de 5 anos. O principal objetivo é restaurar a função e proporcionar alívio da dor a longo prazo, para que você possa usar sua mão com mais conforto.

Antes da cirurgia

Você precisará jejuar antes da sua cirurgia e suspender o uso de determinados medicamentos conforme orientação do seu cirurgião. Por favor, organize alguém para levá-lo(a) para casa e vista roupas confortáveis. Pode ser necessário realizar radiografias, exames de sangue ou uma avaliação anestésica para verificar sua saúde e planejar o melhor cuidado. Seu cirurgião realizará a operação por meio de uma única incisão aberta sobre a articulação. Essa abordagem permite acesso direto para substituir o osso danificado por um novo implante. Você deve levar uma lista de todos os seus medicamentos atuais ao hospital.

No dia da cirurgia

Você chegará ao hospital e conhecerá seu cirurgião e o anestesista. Esta operação será realizada sob anestesia geral. Você estará completamente adormecido durante o procedimento. Alguns pacientes também podem receber um bloqueio nervoso regional para alívio da dor pós-operatória; o anestesista decidirá no dia, com base nas suas circunstâncias individuais.

Seu cirurgião fará um único corte convencional sobre o seu dedo para acessar a articulação. Em seguida, você será levado para o centro cirúrgico. Após a cirurgia, você acordará na sala de recuperação. Sua equipe o monitorará de perto antes de você ser encaminhado para o seu quarto.

O que a cirurgia envolve

O seu cirurgião fará um único corte na parte frontal da articulação do seu dedo. Esta abordagem aberta proporciona acesso claro à área que necessita de reparação. Em alguns procedimentos, a articulação é posicionada ligeiramente fletida para permitir um melhor acesso aos tecidos internos.

No interior, o seu cirurgião remove as superfícies articulares desgastadas e substitui-as por novas peças. Esta substituição da superfície cria uma articulação suave e estável que se move melhor do que as opções mais antigas. Em alguns casos, uma pequena alça de tecido é apertada para apoiar o dedo. Se necessário, o cirurgião também pode fundir a articulação menor abaixo dela para ajudar o seu dedo a mover-se com mais liberdade.

Uma vez que a nova articulação esteja no lugar e a funcionar bem, o seu cirurgião fecha o corte com pontos de sutura. Estes pontos são geralmente absorvíveis ou podem ser removidos mais tarde. É aplicada uma cura para proteger a área à medida que inicia a sua recuperação.

Após a cirurgia

Você acordará em uma enfermaria de recuperação, onde sua dor será controlada com medicação geral. Sua mão será envolta em um curativo, e você poderá usar uma bandagem simples ou órtese para suporte. Seu cirurgião realiza a cirurgia por meio de uma única incisão sobre o dedo. A maioria dos pacientes permanece uma noite no hospital após esta cirurgia, embora alguns possam ir para casa no mesmo dia. Alguém deve permanecer com você nas primeiras 24 horas. Você pode começar a mover os dedos precocemente para proteger o reparo do tendão. A maioria dos pacientes retorna ao trabalho após uma mediana de 8 semanas. Alguns podem sentir dor leve por até 3 meses se apresentavam sensibilidade à palpação antes da cirurgia.

Recuperação

Você sentirá algum inchaço e dor na mão nas primeiras semanas. Isso é normal, pois seu corpo está se recuperando da única incisão feita sobre a articulação. Se você tinha sensibilidade antes da cirurgia, pode notar dor leve por até 3 meses. Seu cirurgião irá orientá-lo sobre como gerenciar esse desconforto em casa.

Sua recuperação envolve um programa de movimento controlado para ajudar você a mover o dedo com segurança. Você trabalhará com um terapeuta ocupacional por cerca de doze semanas para proteger o reparo do tendão enquanto recupera o movimento. Você pode usar uma muleta ou órtese para manter o dedo em uma posição confortável, geralmente flexionado entre 20 e 30 graus. Tarefas simples em casa são possíveis assim que o inchaço diminuir e você puder segurar sem dor.

Sua jornada é única, e seu cronograma pode diferir dos de outras pessoas. Seu cirurgião e fisioterapeuta ajustarão seu plano conforme o movimento retorna. Você progredirá lentamente em direção à função completa, garantindo que sua articulação permaneça estável e móvel. Confie no processo e siga as orientações de sua equipe para obter o melhor resultado.

O que pode dar errado

A maioria dos pacientes tem uma boa evolução, mas problemas podem ocorrer ocasionalmente. O seu cirurgião e a equipa monitorizam-no de perto para detetar qualquer problema precocemente.

Por vezes, o dedo longo não é um bom candidato a esta artroplastia. Se tiver este dedo, o seu cirurgião irá discutir se os riscos são demasiado elevados para si.

As reoperações são comuns após esta cirurgia. A causa mais frequente é um problema no tendão que estende o dedo. Poderá notar que não consegue estender o dedo completamente ou sentir uma fraqueza súbita na mão. Ligue ao seu cirurgião imediatamente se isto acontecer.

Algumas artroplastias podem necessitar de cirurgia de revisão dentro de cinco anos. Poderá também necessitar de mais do que uma operação para corrigir a articulação. Se o seu dedo voltar a doer ou se sentir instável, informe o seu cirurgião imediatamente.

A infeção é incomum após este procedimento. No entanto, se notar vermelhidão a espalhar-se a partir da ferida, dor profunda pulsante que não melhora com analgésicos simples, ou febre, contacte a clínica imediatamente.

Se tiver rigidez grave no dedo devido à doença de Dupuytren, podem ocorrer complicações. Poderá sentir inchaço ou dor aumentados que não melhoram. O seu cirurgião irá discutir o melhor plano para gerir esta situação.

Se tiver artrite em vários dedos, o risco de problemas é semelhante ao de ter apenas um dedo substituído. Deve ainda reportar qualquer nova dor ou perda de movimento à sua equipa.

A tabela de complicações nesta página lista as taxas típicas se desejar os detalhes específicos.

Quando nos ligar

Ligue-nos se tiver febre, vermelhidão crescente ou secreção na ferida. Vá à emergência se sentir dor intensa súbita, inchaço na panturrilha ou falta de ar. Entre em contato conosco imediatamente se perder a sensibilidade ou não conseguir mover o dedo. Você pode ter dor leve por até 3 meses após a cirurgia. Reoperações são comuns, frequentemente devido a problemas nos tendões. Se tiver esses sinais, não espere pela sua próxima consulta.


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