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PIP Joint Arthritis

Osteoarthritis and inflammatory arthritis of the PIP joint — non-operative and surgical options.

80 citationsUpdated Sep 2026
Illustration: PIP Joint Arthritis

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

PIP joint arthroplasty is a reliable surgical option for symptomatic degenerative, post-traumatic, or inflammatory arthritis when performed in the appropriate clinical setting [18]. Silicone implant arthroplasty remains the treatment of choice for the symptomatic osteoarthritic PIP joint, demonstrating an implant survivorship of 90% at an average of 10 years postoperatively [3]. The volar approach to PIP surface replacement arthroplasty can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [2]. While primary PIP arthroplasty utilization for osteoarthritis has increased, revision PIP arthroplasty has decreased [5]. Initial reports of PIP joint surface replacement implants are encouraging, and component loosening typical of earlier designs has not been a problem to date for new-generation implants [24].

Pyrocarbon implants offer a safe and effective treatment for PIP joint arthritis, providing excellent pain relief and increasing the arc of motion by more than double the preoperative range [36]. Clinical outcomes for PIP joint replacements with pyrocarbon implants are variable despite substantially good survivorship [4]. The survival of pyrocarbon PIP joint arthroplasty was 85% at 5 years of follow-up, with high patient satisfaction at that interval [28]. Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis [69]. The Self Locking Finger Joint implant demonstrated good pain relief and overall patient satisfaction while maintaining joint range of motion at minimum 2 years of follow-up [30]. The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint [46].

Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [1]. Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and approximately 1 in 3 will undergo more than 1 operation by 5 years [21]. Intraoperative fractures occur in about 5% of PIP joint arthroplasties but do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications [40]. Minimizing postoperative complications after PIP joint arthroplasty is one avenue to decrease health care costs [63]. PIP joint arthrodesis is an excellent option for surgical management of PIP joint arthritis with an excellent overall success rate and very few contraindications [7]. PIP joint denervation provides durable, effective pain relief with high patient satisfaction despite osteoarthritis progression, supporting its consideration as a surgical option for symptomatic PIP joint osteoarthritis [8]. Ultimate salvage for the failed PIP joint arthroplasty may require arthrodesis or even amputation [9].

Anatomy & Pathophysiology

Joint Mechanics and Stability

The proximal interphalangeal (PIP) joint functions as a simple hinge joint, permitting motion exclusively in the flexion-extension axis [55]. Stability in full extension relies on the highly congruent bony architecture [55], whereas flexion stability is maintained by capsuloligamentous structures, including the dorsal capsule, volar plate, and collateral ligaments [55]. The collateral ligaments remain essentially isometric throughout the arc of motion [55]. The internal structure and material properties of the phalanges significantly influence both the magnitude and distribution of stresses within finger joints [94]. Because proper biomechanics must be restored to achieve full, functional range of motion [89], maintaining motion and function following trauma or surgery remains challenging [12]. The PIP joint is prone to injury and residual deformity [34]; an extensive review of 96 injuries identified a 30% poor recovery rate characterized by joint instability, poor function, pain, or flexion deformities [34].

Extensor Mechanism Anatomy

The principal bony insertion of the extrinsic digital extensors is on the dorsal proximal aspect of the middle phalanx [52]. Metacarpophalangeal joint extension is provided by extrinsic extensor force transmitted through the sagittal bands [52], while distal interphalangeal joint extension is achieved through conjoined lateral bands composed of tendinous slips from extrinsic and intrinsic tendons [52]. The deep head of each dorsal interosseous muscle forms a lateral tendon, or lateral band, at the level of the metacarpophalangeal joint [75]. Transverse fibers arch dorsally from each lateral band to join over the dorsum of the finger, flexing the proximal phalanx [75]. Oblique fibers from the lateral bands sweep over the distal third of the proximal phalanx to insert onto the lateral tubercles at the base of the middle phalanx, extending the PIP joint [75]. The lateral bands are joined by the lateral slips of the extensor tendon to form the conjoined lateral band [75]. The two conjoined lateral bands unite at the distal third of the middle phalanx to form the terminal tendon, which inserts at the base of the distal phalanx to extend it [75].

The flexor digitorum superficialis tendon bifurcates around the flexor digitorum profundus at the beginning of the A2 pulley [81]. It inserts via radial and ulnar slips into the proximal metaphysis of the middle phalanx [81], with its primary function being digital flexion at the PIP joint [81]. The A3 annular pulley is located over the PIP joint [81].

Pathophysiology of Deformity and Arthritis

The boutonniere deformity is characterized by a flexion posture of the PIP joint and a hyperextension posture of the distal interphalangeal (DIP) joint [72]. Persistent synovitis of the PIP joint causes attenuation of the central slip, transverse retinacular ligaments, and triangular ligament [72]. Weakening of the central slip and associated structures leads to volar subluxation of the lateral bands relative to the axis of rotation of the PIP joint [72]. This volar subluxation converts the lateral bands from PIP joint extensors to PIP joint flexors [72]. With persistence of PIP joint flexion, the volar plate, collateral ligaments, and oblique retinacular ligaments become contracted, leading to a fixed contracture [72].

Stage 1 boutonniere deformity is classified as a passively correctable PIP joint flexion deformity of 10° to 15° with minimal functional loss [22]. In this stage, there is typically full passive PIP extension [22], and loss of function can be attributed to limited DIP flexion [22]. The most important factor in the development of finger deformities is the changes occurring in the tendons and related structures, especially in early stages [102]. The pathogenesis of PIP joint contracture is attributed to a cycle of edema, immobilization, and tissue adherence of the capsuloligamentous structures [55].

Osteoarthritis is a complex disease resulting in the failure of articular cartilage due to a combination of genetic, metabolic, biochemical, and biomechanical factors [32]. Cartilage loss and reactive new bone formation at joint margins are accompanied by the proliferation of osteoarticular tissue in the capsule [32]. The pathogenesis of the early stages of osteoarthritis is poorly understood, with emphasis placed on the role of cartilage, subchondral bone, and soft tissue structures such as collateral ligaments and tendons [32]. High-resolution magnetic resonance imaging findings raise important questions about the role of ligaments in hand osteoarthritis [66]. Women with hand osteoarthritis exhibited significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types [87]. People with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with controls [113].

Injury Mechanisms and Structural Failure

Dorsal PIP dislocations are characterized by forced hyperextension, axial load, and radial or ulnar deviation [137]. These injuries involve volar plate rupture at its distal attachment [137] and a split between the accessory collateral ligament and proper collateral ligament with detachment of the proper collateral ligament from its proximal attachment [137]. In dorsal PIP dislocations, the volar plate is maintained beneath the condyle, held by intact attachment to the accessory collateral ligament [137].

Lateral PIP dislocations result from a laterally directed force causing avulsion of the collateral ligament from its proximal attachment on the side of the applied force [135]. Continued force causes the volar plate to tear on the side of injury, resulting in lateral dislocation [135]. In uncomplicated lateral PIP dislocations, the central slip of the extensor mechanism ruptures or avulses from the dorsal lip of the middle phalanx [135]. Failure to immobilize the joint in extension after central slip rupture can lead to stretching of the triangular ligament holding the lateral bands [135]. Stretching of the triangular ligament results in volar subluxation of the lateral bands, which can no longer extend the PIP joint [135]. Tightening of the terminal extensor slip following lateral band subluxation leads to hyperextension of the distal interphalangeal joint [135].

Volar PIP dislocations are rare and require force in two vectors: ulnar or radial deviation causing rupture of the collateral ligament and volar plate, combined with an anteriorly directed force [137].

Chronic unreduced dislocations of the PIP joint are defined as persistent dislocation or subluxation due to late presentation or missed injury for 4 weeks or more [13]. Closed reduction of chronic PIP joint dislocations is rarely successful owing to soft tissue contractures [13]. However, a functional range of motion with a stable joint can be achieved in chronic PIP dislocations as long as articular cartilage is relatively preserved [13]. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand [58]. Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [1].

Classification

Diagnostic Basis: The diagnosis of PIP joint osteoarthritis relies primarily on the clinical presentation, with radiographs serving to confirm the condition [35]. Because radiographic findings and symptoms do not correlate in this pathology, classifications and staging systems based solely on radiographs are rarely utilized [35]. However, radiographic evaluation of bone quality, specifically defects and cyst formation, plays a crucial role in determining indications for surgical treatment options [35]. The presence of stiffness and deformity similarly plays a crucial role in the indication of possible surgical treatment options for PIP joint arthritis [35].

PIP-Kellgren: A proposed PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment for PIP joint osteoarthritis [37].

SCARF: The SCARF classification system allows non-hand specialists to specify the type of every PIP joint dislocation and understand each case [57].

Nalebuff: Nalebuff’s classification system for boutonniere deformity comprises three stages based on the passive correctability of the PIP joint flexion deformity and the condition of the articular surfaces [72]. Stage 1 is characterized by synovitis of the PIP joint and a slight, fully correctable extensor lag [72]. It is defined as a passively correctable PIP joint flexion deformity of 10° to 15° (extension lag) with minimal functional loss [22]. Stage 2 consists of a marked flexion deformity of the PIP joint [72].

Other Considerations: The boutonniere deformity is characterized by a flexion posture of the PIP joint and a hyperextension posture of the DIP joint [72]. The inciting event is persistent synovitis of the PIP joint, which causes attenuation of the central slip, transverse retinacular ligaments, and triangular ligament [72]. Weakening of these structures causes lateral bands to subluxate volar to the axis of rotation of the PIP joint [72]. This volar subluxation causes the lateral bands to become PIP joint flexors rather than extensors [72]. With persistence of PIP joint flexion, the volar plate, collateral ligaments, and oblique retinacular ligaments become contracted, leading to a fixed contracture of the joint [72]. Treatment of PIP joint fracture dislocations is based on joint stability, fracture fragment size, and soft tissue injuries [45]. Early recognition of joint instability is essential for adequate treatment of injuries of the PIP joint [38].

Clinical Presentation

Diagnosis and Radiographic Findings

Radiographic findings and clinical symptoms in PIP joint arthritis do not correlate, which is the primary reason that classifications and staging based solely on radiographs are rarely used [35]. Despite this discrepancy, radiographic evaluation of bone quality, specifically defects and cyst formation, plays a crucial role in determining possible surgical treatment options [35]. The initial phase of PIP joint osteoarthritis is an inflammatory process that comes to a halt at a later stage [35]. Consequently, many patients have fewer symptoms at the end stage of PIP joint osteoarthritis than at the beginning [35]. A proposed PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment [37].

Symptoms and Functional Status

Patients are considered for PIP joint arthroplasty if they have radiological signs of osteoarthritis (Kellgren-Lawrence classification ≥grade 2) in combination with pain, despite nonsurgical treatment for at least 3 months [20]. Stiffness and deformity can also be indications for PIP joint surgery [20]. In a series of initial PIP joint arthroplasties, the most common indications were stiffness (28%) and pain (25%) [26]. It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains [27].

In trigger finger patients, PIP joint pain results from long symptom duration and consequent joint pathology [29]. This pain is incompletely resolved after A1 pulley release, leading to worse surgical outcomes than expected [29]. Patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after A1 pulley release surgery [67]. PIP joint stiffness remains an unsolved problem in hand surgery, with poor prognosis in complex cases even after complete arthrolysis and tenolysis [100].

Deformity and Contracture

Indications for surgical treatment of Stage 1 boutonniere deformity include persistent synovitis that has failed nonsurgical treatment and deformities that interfere with activities but are passively correctable [22]. Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon and defined as persistent dislocation or subluxation of the joint due to late presentation or missed finger injury for 4 weeks or more [13]. Fracture dislocations of the PIP joint may rapidly develop fixed deformity, leaving a patient with a poor outlook for complete correction [59]. Clinical results for PIP joint dislocations and fracture-dislocations vary and are often difficult to predict due to the complexity of fracture patterns and potential for sub-acute or chronic presentation [60].

Inflammatory Arthritis

Early diagnosis of rheumatoid arthritis is important, and referral to a rheumatologist followed by treatment with disease-modifying antirheumatic agents has been shown to improve outcomes [117]. Serial casting is an effective method to correct flexion contractures in PIP joints in selected patients with arthritis [17].

Investigations

Plain radiography: Patients are considered for PIP joint arthroplasty when radiological signs of PIP joint osteoarthritis, defined as Kellgren-Lawrence classification ≥grade 2, are present in combination with pain despite nonsurgical treatment for at least 3 months [20]. The proposed PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment [37].

MRI: High-resolution magnetic resonance imaging findings raise questions about the role of ligaments in hand osteoarthritis [66].

CT: High-resolution peripheral quantitative CT (HR-pQCT) and microCT commonly visualize cortical breaks in MCP and PIP joints [131].

Treatment

Non-Operative

Collagenase enzymatic fasciotomy yields variable results in PIP joints, with clinical success occurring in 27% of joints after one injection and 34% after the last injection [47]. Clinical improvement was observed in 49% of joints after one injection and 58% after the last injection [47]. Range of motion increased from 51 to 71 degrees after the first injection and to 75 degrees after the last injection [47]. In trigger finger patients, PIP joint pain resulting from long symptom duration and consequent joint pathology is incompletely resolved after A1 pulley release [29].

Operative

Indications: Silicone implant arthroplasty remains the treatment of choice for the symptomatic osteoarthritic PIP joint [3]. PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [18]. The TACTYS prosthesis should be proposed exceptionally if PIP joint arthritis causes invalidating functional pain [14]. Indications for the PIP-SRA include primary degenerative osteoarthritis or post-traumatic arthritis in elderly, less-active patients who desire to maintain PIPJ motion and avoid PIPJ arthrodesis [62]. The SR PIP implant is used for moderate- to high-demand patients with pain due to osteoarthritis, posttraumatic arthritis, or rheumatoid arthritis without major bone loss [105]. Pre-requisites for PIP joint arthroplasty are intact tendons and at least some residual joint stability [124].

Contraindications: Use of the PIP-SRA is not indicated in patients with rheumatoid arthritis or other inflammatory arthritis because of the effect of these arthritides on soft-tissue integrity [62]. Contraindications for the PIP-SRA include current or chronic infection, loss of extensor mechanism or flexor tendon function, poor soft-tissue envelope, absent collateral ligament function, and incompetence of the PIPJ volar plate [62]. Relative contraindications for the PIP-SRA include the presence of a static swan-neck or boutonnière deformity [62]. Coronal angulation of greater than 15° is a contraindication to SR PIP arthroplasty [105]. Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [25]. Corrections of a lateral deviation beyond 30° are difficult and likely to fail in PIP arthroplasty [124].

Implant Selection: Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief [130], with an implant survivorship of 90% at an average of 10 years postoperatively [3]. Silicone implant arthroplasty is a common and generally successful surgery for the correction of painful stiffness due to underlying arthropathy, with pain relief and patient satisfaction being generally reliable [129]. Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [19]. Surface replacement arthroplasty of the PIP joint offers motion and stability for the index finger unattainable with silicone arthroplasty [42]. The SR PIP implant is an effective alternative to fusion in the index PIP joint when motion is desired [105]. The minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion [30]. Pyrocarbon PIPJ replacement is a safe and effective treatment for arthritis of the PIPJ, providing excellent pain relief and increasing the arc of motion by more than double the preoperative range [36]. The survival of pyrocarbon PIP joint arthroplasty was 85% at 5 years of follow-up, with high patient satisfaction [28]. Despite substantially good survivorship, clinical outcomes for PIP joint replacements with pyrocarbon implants are variable [4]. Patients should be advised that PIPJ ROM deteriorates over time following pyrolytic carbon hemiarthroplasty [16].

Arthrodesis: PIPJ arthrodesis has very few contraindications, with an excellent overall success rate, making it an excellent option for surgical management of PIPJ arthritis [7]. Various techniques for PIP joint arthrodesis can achieve good functional results, but no optimal procedure has yet been found due to the diversity of available methods [23]. Arthrodesis in the radial digits brought an improvement in the lateral pinch, while arthroplasty in the ulnar digits gave reasonable functional mobility with good pain relief [124].

Denervation: Denervation is an effective treatment for painful PIP osteoarthritis, providing lasting pain relief while conserving range of motion [104].

Other Procedures: External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results [33]. An extensile midaxial approach to the proximal interphalangeal joint allows for release of contractures, open reduction, and repair of critical structures in chronic unreduced dislocations [13]. Surgical treatment for congenital PIP joint contracture should proceed in a stepwise manner, with goals of placing the digit in a more functional and extended position while maintaining finger flexion [39]. Persistent synovitis leading to a progressive boutonniere deformity can be treated with surgical synovectomy [22].

Postoperative Rehabilitation: The postoperative rehabilitation protocol for PIP arthroplasty involves a dynamic PIP extension-assist splint limiting ROM to 0° to 30° of extension-flexion for the first week [64]. A static resting splint is worn at night and during rest periods, with the MCP joint in 20° of flexion and the PIP and DIP joints maintained in full extension [64]. Patients with rheumatoid arthritis may require up to 3 weeks of immobilization before initiation of therapy following PIP arthroplasty to provide for soft tissue repair healing [64]. If hyperextension of the PIP joint is present postoperatively, an extension block can be added to block the PIP joint at 30° or more of flexion, with a night static flexion block at 60° to 90° for 3 weeks [64].

Revision and Outcomes: Reoperations following primary non-constrained PIP arthroplasties are common [11]. Data from the Medicare database demonstrate an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased [5].

Complications

Arthroplasty Complications

Overall Revision and Re-operation: Implant arthroplasty of the PIP joint has historically suffered from high rates of complications [138]. Approximately 1 in 3 PIP joint arthroplasties with a pyrocarbon implant will undergo more than one operation [21]. The revision rate for the LPM PIPJ prosthesis was 29% at a maximum follow-up of 6 years [61]. Clinical outcomes for PIP joint replacements with pyrocarbon implants are variable [4].

Functional Deterioration: Patients should be advised that PIPJ range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [16]. An additional 20% of patients with the LPM PIPJ prosthesis experienced adverse clinical and radiological outcomes at a maximum follow-up of 6 years [61].

Infection (PJI): Periprosthetic joint infection is uncommon after PIP arthroplasties [31]. In multi-digit PIP joint arthroplasty during a single operation, 3% of cases involved infections [71]. With multi-digit PIP joint arthroplasty occurring on two or more different dates, 4% of cases involved infections [71].

Periprosthetic Fracture: With multi-digit PIP joint arthroplasty during a single operation, 7% of cases involved intraoperative fractures and 1% of cases involved postoperative fractures [71]. With multi-digit PIP joint arthroplasty occurring on two or more different dates, 12% of cases involved intraoperative fractures and 2% of cases involved postoperative fractures [71].

Injury and Non-Arthroplasty Complications

Chronic Sequelae: Complications regularly arise after PIP joint injuries [15]. Inappropriate management of PIP joint injuries may result in chronic pain, stiffness, deformity, or premature degenerative arthritis [34].

Adjacent Joint Pain: Proximal interphalangeal joint pain in trigger finger patients is incompletely resolved after A1 pulley release [29]. Proximal interphalangeal joint pain in trigger finger patients leads to worse surgical outcomes than expected [29].

Recovery

Light activity (weeks): The evidence does not specify a typical week range for desk work, driving, or light activities of daily living.

Full activity (months): The evidence does not specify a month range for manual work, sport, or full range of motion and strength return.

Complete recovery / outcome plateau (months): The evidence does not specify a month range for the stabilization of pain, strength, and final functional outcomes.

Rehabilitation protocol: The postoperative rehabilitation protocol for PIP arthroplasty involves a dynamic PIP extension-assist splint worn during the day and a static resting splint worn at night [64]. The dynamic PIP extension splint limits range of motion to 0° to 30° of extension-flexion for the first week [64]. The static resting splint maintains the MCP joint in 20° of flexion and the PIP and DIP joints in full extension [64]. All exercises in the dynamic splint should be done hourly with ten repetitions [64]. Hyperextension and extension lag should be avoided, with therapy/splinting adjusted immediately when either is present [64]. When hyperextension of the PIP joint is present, an extension block can be added to block the PIP joint at 30° or more of flexion [64]. An extension block for hyperextension includes a night static flexion block at 60° to 90° for 3 weeks [64]. After the 3-week period of extension blocking, dynamic extension is reinstituted to zero [64]. Patients with rheumatoid arthritis may require up to 3 weeks of immobilization before initiation of therapy following PIP arthroplasty [64]. Therapy starting 1 week after surgery requires close monitoring to ensure proper alignment, rotation, and position [64]. Using night progressive static and daily dynamic orthoses as an exclusive treatment during the proliferative phase led to significant improvements in the PIP joint active extension [139].

Functional milestones: Improvement in PIP joint active extension from orthotic intervention did not correlate with increased function as perceived by the patient [139].

Other Considerations: PIP joint range of motion deteriorates over time in patients with pyrolytic carbon hemiarthroplasty [16]. Approximately 1 in 3 PIP joint arthroplasties with a pyrocarbon implant will undergo more than 1 operation [21]. Pyrocarbon PIP joint arthroplasty is associated with high patient satisfaction at 5 years of follow-up [28]. The survival of the MatOrtho proximal interphalangeal joint arthroplasty was 85% at a minimum of 2-years follow-up [128]. PIP range of motion after surface replacement arthroplasty through a volar approach has the tendency to deteriorate with longer follow-up [73]. Initial reports of PIP and MCP joint surface replacement implants are encouraging because component loosening typical of earlier designs has not been a problem to date [24]. Complications regularly arise after PIP joint injuries, yet they can often be prevented through early detection of injury and appropriate initial treatment protocols [15]. Proximal interphalangeal joint pain in trigger finger patients is incompletely resolved after A1 pulley release, leading to worse surgical outcomes than expected [29]. Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure [70]. Surgery performed better than collagenase at early and 2-year follow-up in PIP joints [6].

Key Evidence

  • [L4] Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause. [1] (10.1016/j.jhsa.2011.06.002)
  • [L4] The volar approach to PIP SRA can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis. [2] (10.1016/j.jhsa.2011.03.003)
  • [L4] With an implant survivorship of 90% at average of 10 years postoperatively, silicone implant arthroplasty remains the treatment of choice for the symptomatic osteoarthritic PIP joint. [3] (10.1016/j.jhsa.2013.11.008)
  • [L4] Despite substantially good survivorship, clinical outcomes for PIP joint replacements with pyrocarbon implants are variable. [4] (10.1302/2058-5241.2.160041)
  • [L4] The data demonstrate an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased. [5] (10.1177/1558944719837009)
  • [L3] Surgery performed better than collagenase at early and 2-year follow-up in PIP joints and similarly in MCP joints. [6] (10.1007/s00402-018-3034-6)
  • [L5] PIPJ arthrodesis has very few contraindications, with an excellent overall success rate, making it an excellent option for surgical management of PIPJ arthritis. [7] (10.1016/j.hcl.2017.12.007)
  • [L4] PIP joint denervation provides durable, effective pain relief with high patient satisfaction, despite osteoarthritis progression, supporting its consideration as a surgical option for symptomatic PIP joint osteoarthritis. [8] (10.1016/j.jhsa.2026.01.033)
  • [L5] Ultimate salvage for the failed PIP joint arthroplasty may require arthrodesis or even amputation. [9] (10.1016/j.hcl.2017.12.011)
  • [L4] Reoperations following primary non-constrained PIP arthroplasties are common. [11] (10.1016/s0363-5023(11)60049-x)
  • [L5] Maintaining motion and function following trauma and/or surgery of the PIP joint remains very challenging. [12] (10.1016/j.hcl.2017.12.003)
  • [L4] [13] (10.1016/j.jhsa.2020.07.002)
  • [L4] It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain. [14] (10.1177/15589447211030962)
  • [L5] Complications regularly arise after PIP joint injuries, yet they can often be prevented through early detection of injury and appropriate initial treatment protocols. [15] (10.1016/j.hcl.2017.12.014)
  • [L4] Patients should be advised that PIPJ ROM deteriorates over time. [16] (10.1016/j.jhsa.2023.11.007)
  • [L4] SC is an effective method to correct flexion contractures in PIP joints in selected patients with arthritis. [17] (10.1016/j.jht.2015.11.005)
  • [L4] PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. [18] (10.1177/17531934241265837)
  • [L4] Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function. [19] (10.1016/j.jhsa.2008.11.005)
  • [L3] [20] (10.1177/15589447221141485)
  • [L4] Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. [21] (10.1016/j.jhsa.2018.06.020)
  • [L5] [22] (10.1016/j.jhsa.2011.05.029)
  • [Paper] The review concludes that while various techniques for PIP joint arthrodesis can achieve good functional results, no optimal procedure has yet been found due to the diversity of available methods. [23] (10.1055/a-0833-8729)
  • [L5] Initial reports of PIP and MCP joint surface replacement implants are encouraging, particularly because component loosening typical of earlier designs has not been a problem to date. [24] (10.5435/00124635-200309000-00002)
  • [L1] Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. [25] (10.1177/1558944718791186)
  • [Paper] [26] (10.1055/s-0040-1709088)
  • [L4] It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. [27] (10.1016/j.jhsa.2023.01.025)
  • [L4] The survival of pyrocarbon PIP joint arthroplasty was 85% at 5 years of follow-up, with high patient satisfaction. [28] (10.1016/j.jhsa.2012.02.012)
  • [L4] Proximal interphalangeal joint pain in trigger finger patients results from long symptom duration and consequent joint pathology, and is incompletely resolved after A1 pulley release, leading to worse surgical outcomes than expected. [29] (10.1177/1753193418809771)
  • [L4] The minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion. [30] (10.1177/1558944717726136)
  • [L4] PJI is uncommon after MCP or PIP arthroplasties. [31] (10.1016/j.jhsa.2024.12.008)
  • [L5] [32] (10.1016/j.jhsa.2010.09.003)
  • [L4] External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results. [33] (10.1016/j.jhsa.2013.07.007)
  • [L5] [34] (10.1016/j.hcl.2006.05.003)
  • [L5] [35] (10.1016/j.hcl.2017.04.002)
  • [L4] Pyrocarbon PIPJ replacement is a safe and effective treatment for arthritis of the PIPJ, providing excellent pain relief and increasing the arc of motion by more than double the preoperative range. [36] (10.1177/1753193411434053)
  • [L4] The proposed PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment. [37] (10.1016/j.jhsg.2025.100911)
  • [L5] Early recognition of joint instability is essential for adequate treatment of injuries of the PIP joint. [38] (10.5435/00124635-200011000-00006)
  • [L5] Surgical treatment should proceed in a stepwise manner, and patient expectations must be managed preoperatively with the goals of placing the digit in a more functional and extended position while maintaining finger flexion. [39] (10.1016/j.hcl.2017.12.013)
  • [L3] Intraoperative fractures occur in about 5% of PIP joint arthroplasties and do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications. [40] (10.1016/j.jhsa.2015.06.101)
  • [L4] Surface replacement arthroplasty of the PIP joint holds promise for the future, offering motion and stability for the index finger unattainable with silicone arthroplasty. [42] (10.1016/j.jhsa.2008.06.008)
  • [L5] This article serves as a reference for the current understanding and best practices in treating PIP joint fracture dislocations, emphasizing that treatment is based on joint stability, fracture fragment size, and soft tissue injuries. [45] (10.1016/j.hcl.2017.12.005)
  • [L4] The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint. [46] (10.1177/1753193420977244)
  • [L2] [47] (10.1016/j.jhsa.2015.02.018)
  • [L5] [55] (10.1016/j.jhsa.2015.06.118)
  • [L2] Even other than hand specialists can specify the type of every PIP joint dislocation by using the SCARF classification and will have better understanding of each case. [57] (10.1016/j.jos.2019.08.007)
  • [L5] Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. [58] (10.1177/1753193414559464)
  • [L5] Timely diagnosis is imperative, especially if there is any persistent incongruity of the joint, as fracture dislocations of the PIP joint may rapidly develop fixed deformity, leaving an athlete with a poor outlook for complete correction. [59] (10.1016/j.hcl.2012.05.036)
  • [L5] Clinical results for PIP joint dislocations and fracture-dislocations vary and are often difficult to predict due to the complexity of fracture patterns and potential for sub-acute or chronic presentation. [60] (10.1177/17531934231183259)
  • [L4] The revision rate of 29% and a further 20% rate of adverse clinical and radiological outcomes for the LPM PIPJ prosthesis at a maximum follow-up of 6 years is unacceptable. [61] (10.1177/1753193408094920)
  • [L4] [62] (10.1016/j.jhsa.2007.04.012)
  • [L3] Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs. [63] (10.1016/j.jhsa.2019.11.002)
  • [L5] [64] (10.5435/00124635-200703000-00009)
  • [L4] The findings also raise important questions about the role of ligaments in hand OA. [66] (10.1002/art.21210)
  • [L2] Patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after surgery. [67] (10.1186/s12891-023-06130-5)
  • [L4] Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis. [69] (10.1016/j.jhsa.2014.12.016)
  • [L4] Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. [70] (10.1186/s12891-020-03310-5)
  • [L4] [71] (10.1177/1753193418765691)
  • [L5] [72] (10.5435/00124635-199903000-00002)
  • [L4] PIP ROM after SRA through a volar approach has the tendency to deteriorate with a longer follow-up. [73] (10.1177/1558944718787332)
  • [L3] Women with hand osteoarthritis exhibited significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types. [87] (10.1016/j.jht.2024.02.005)
  • [L5] Proper biomechanics of a joint must be restored to achieve full, functional range of motion. [89] (10.1016/j.hcl.2017.12.008)
  • [L5] The internal structure and material properties of the phalanges were found to play a significant role in both the magnitude and distribution of stresses. [94] (10.1007/s11552-012-9430-4)
  • [L5] PIP joint stiffness remains an unsolved problem in hand surgery, with poor prognosis in complex cases even after complete arthrolysis and tenolysis. [100] (10.1177/17531934221143690)
  • [L4] The most important factor in the development of finger deformities is the changes occurring in the tendons and related structures, especially in early stages. [102] (10.2106/00004623-195739030-00006)
  • [L4] Denervation is an effective treatment for painful PIP osteoarthritis, providing lasting pain relief while conserving range of motion. [104] (10.1016/j.otsr.2021.102976)
  • [L4] [105] (10.1016/j.jhsa.2014.11.015)
  • [L3] This study demonstrated that people with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with the controls, and that with instruction on joint protection techniques, participants made significant changes in the amount of movement used to perform tasks, which supports a proof of principle of joint protection. [113] (10.1016/j.jht.2020.10.010)
  • [L5] Early diagnosis of rheumatoid arthritis is important, and referral to a rheumatologist followed by treatment with disease-modifying antirheumatic agents has been shown to improve outcomes. [117] (10.1016/j.jhsa.2011.01.036)
  • [L5] [124] (10.1302/2058-5241.4.180042)
  • [L4] The survival of the MatOrtho proximal interphalangeal joint arthroplasty was 85% at a minimum of 2-years follow-up. [128] (10.1177/1753193415614251)
  • [L4] Silicone implant arthroplasty of the PIP joint remains a common and generally successful surgery for the correction of painful stiffness due to underlying arthropathy, with pain relief and patient satisfaction being generally reliable. [129] (10.1016/j.jhsa.2007.04.013)
  • [L4] Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. [130] (10.1177/1558944718769427)
  • [L4] Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and microCT. [131] (10.1186/s12891-016-1148-y)
  • [L5] [135] (10.1016/j.hcl.2009.05.008)
  • [L5] [137] (10.1016/j.hcl.2017.12.004)
  • [L4] Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction but has historically suffered from high rates of complications. [138] (10.1016/j.jhsa.2017.07.030)
  • [L1] Using night progressive static and daily dynamic orthoses as an exclusive treatment during the proliferative phase led to significant improvements in the PIP joint active extension, but the improvement did not correlate with increased function as perceived by the patient. [139] (10.1016/j.jhsa.2015.01.005)

See Also

References

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[2] Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint Using a Volar Approach: Case Series. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.03.003

[3] Long-Term Results of Swanson Silicone Arthroplasty for Proximal Interphalangeal Joint Osteoarthritis. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.11.008

[4] Proximal interphalangeal (PIP) joint replacements with pyrolytic carbon implants in the hand. EFORT Open Reviews. 2017. DOI: 10.1302/2058-5241.2.160041

[5] Trends in Primary Proximal Interphalangeal Joint System and Revisions for Osteoarthritis of the Hand in the Medicare Database. HAND. 2019. DOI: 10.1177/1558944719837009

[6] Range of motion, postoperative rehabilitation and patient satisfaction in MCP and PIP joints affected by Dupuytren Tubiana stage 1–3: collagenase enzymatic fasciotomy or limited fasciectomy? A clinical study in 52 patients. Archives of Orthopaedic and Trauma Surgery. 2018. DOI: 10.1007/s00402-018-3034-6

[7] Proximal Interphalangeal Joint Fusion. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.007

[8] Long-term Survival of Proximal Interphalangeal Joint Denervation of the Hand: Time-to-Event Analysis. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.033

[9] Salvaging a Failed Proximal Interphalangeal Joint Implant. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.011

[11] Reoperations following Proximal Interphalangeal Joint Unconstrained Arthroplasty. The Journal of Hand Surgery. 2011. DOI: 10.1016/s0363-5023(11)60049-x

[12] Surgical Exposure of the Proximal Interphalangeal Joint. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.003

[13] Open Reduction of Neglected Dislocations of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.07.002

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[20] Type of Work and Preoperative Ability to Perform Work Affect Return to Usual Work Following Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis. HAND. 2022. DOI: 10.1177/15589447221141485

[21] Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.06.020

[22] Treatment of Boutonniere Finger Deformity in Rheumatoid Arthritis. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.05.029

[23] Die Arthrodese des Fingermittelgelenkes: eine Literaturanalyse. Handchirurgie · Mikrochirurgie · Plastische Chirurgie. 2019. DOI: 10.1055/a-0833-8729

[24] New-Generation Implant Arthroplasties of the Finger Joints. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200309000-00002

[25] Prosthetic Arthroplasty of Proximal Interphalangeal Joints for Treatment of Osteoarthritis and Posttraumatic Arthritis: Systematic Review and Meta-Analysis Comparing the Three Ulnar Digits With the Index Finger. HAND. 2018. DOI: 10.1177/1558944718791186

[26] Factors Associated with Reoperation after Pyrocarbon Proximal Interphalangeal Joint Arthroplasty for the Arthritic Joint: A Retrospective Cohort Study. Journal of Hand and Microsurgery. 2021. DOI: 10.1055/s-0040-1709088

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[29] Clinical significance of proximal interphalangeal joint pain in patients with trigger fingers. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418809771

[30] Outcomes of Surface Replacement Proximal Interphalangeal Joint Arthroplasty Using the Self Locking Finger Joint Implant: Minimum Two Years Follow-up. HAND. 2017. DOI: 10.1177/1558944717726136

[31] Incidence and Presentation of Periprosthetic Joint Infection After Primary Metacarpophalangeal and Proximal Interphalangeal Arthroplasty. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.12.008

[32] Osteoarthritis of the Distal Interphalangeal Joint. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.09.003

[33] Distraction for Proximal Interphalangeal Joint Contractures: Long-Term Results. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.07.007

[34] Management of Proximal Interphalangeal Joint Injuries. Hand Clinics. 2006. DOI: 10.1016/j.hcl.2006.05.003

[35] Current European Practice in the Treatment of Proximal Interphalangeal Joint Arthritis. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2017.04.002

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[37] Short-Term Outcomes of Digitalis Silicone Implant for Proximal Interphalangeal Joint Osteoarthritis and a Proposed Functional-Radiological Classification. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100911

[38] Fractures of the Proximal Interphalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 2000. DOI: 10.5435/00124635-200011000-00006

[39] Treating Congenital Proximal Interphalangeal Joint Contracture. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.013

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[42] Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint Using the PIP-SRA Implant: Results, Complications, and Revisions. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.06.008

[45] Management of Proximal Interphalangeal Joint Fracture Dislocations. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.005

[46] Surface replacing arthroplasty of the proximal interphalangeal joint using the CapFlex-PIP implant: a prospective study with 5-year outcomes. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420977244

[47] Efficacy and Safety of Collagenase Clostridium Histolyticum in the Treatment of Proximal Interphalangeal Joints in Dupuytren Contracture: Combined Analysis of 4 Phase 3 Clinical Trials. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.02.018

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[57] Ratio of dislocation types of the proximal interphalangeal joint of the fingers: A new classification system for initial therapy. Journal of Orthopaedic Science. 2019. DOI: 10.1016/j.jos.2019.08.007

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[63] National Prevalence of Complications and Cost of Small Joint Arthroplasty for Hand Osteoarthritis and Post-Traumatic Arthritis. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.11.002

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[69] Pyrolytic Carbon Hemiarthroplasty in the Management of Proximal Interphalangeal Joint Arthritis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.016

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a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.