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PIP joint fusion

Surgeon-side topic for pip joint fusion. Backed by 432 articles from the corpus, retrieved via combined MeSH + title-text matching.

91 citationsUpdated Sep 2026

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Overview

Proximal interphalangeal (PIP) joint arthroplasty is a reliable option for symptomatic degenerative, post-traumatic, or inflammatory arthritis when performed in the appropriate clinical setting [9]. While various implant designs, including silastic, pyrocarbon, and self-locking systems, demonstrate good pain relief and patient satisfaction while maintaining range of motion [19, 20, 28], the procedure is not without risk. 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 one operation [6]. Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [2]. Treatment of the long finger may be a relative contraindication to PIP joint arthroplasty [31].

Arthrodesis serves as an ultimate salvage procedure for a failed PIP joint arthroplasty, alongside amputation [1]. Although achieving solid fusion is not completely reliable or without complication, patients' subjective and functional outcomes demonstrate fair to good results [17]. Risks of nonunion and reoperation after PIP joint arthrodeses are low [7], and available arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes [4]. Volar plate interposition arthroplasty may be a good therapeutic option for posttraumatic arthritis in PIP joints [5].

Combining PIP joint arthroplasty with distal interphalangeal (DIP) joint arthrodesis presents unique challenges regarding hardware conflict [36]. Preliminary results encourage considering this combination to increase range of motion, despite study limitations of small sample size and short follow-up [13]. One-year outcomes for the combined procedure are similar to those achieved by PIP joint replacement alone [24], and the combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility [26]. K-wires offer the easiest compatibility for combined procedures, while headless screws must ideally not reach proximal to the midpoint of the middle phalanx [36].

Anatomy & Pathophysiology

Bony Anatomy

The hand skeleton comprises 27 bones, 19 of which are long bones [51]. It is organized into five rays, each forming a polyarticulated chain of metacarpals and phalanges [51]. The index metacarpal is the longest, while the thumb metacarpal is the shortest [51]. The proximal and middle phalanges of the middle and ring fingers are longer than those of the index finger [51]. Epiphyseal plates in the phalanges are located at their proximal ends [51]. The transverse palmar axis is oblique, forming an acute angle of approximately 75 degrees with the longitudinal axis [51]. Regarding geometric characteristics, the third toe proximal phalanx distal articular surface more closely matched the finger proximal phalanx distal articular surface than did the toe middle phalanx distal articular surface [102].

Joint Mechanics & Kinematics

The PIP joint is a simple hinge joint allowing motion only in the flexion-extension axis [97]. Stability in full extension is maintained by highly congruent bony architecture, whereas stability in flexion relies on capsuloligamentous structures including the dorsal capsule, volar plate, and collateral ligaments [97]. The PIP joint collateral ligaments are essentially isometric throughout the arc of motion [97]. The axes of flexion for the metacarpophalangeal and proximal interphalangeal joints are arranged so that flexion causes the fingers to converge toward the scaphoid [90]. The wrist influences the position of the metacarpophalangeal joint, which affects the position of the proximal interphalangeal joint, which in turn affects the distal interphalangeal joint [87]. Proper biomechanics of a joint must be restored to achieve full, functional range of motion [94]. Patterns of peri-articular finger injuries differ greatly between the three finger joints due to the mechanism of falling and local biomechanical forces [92].

Extensor Mechanism

The principal bony insertion of the extrinsic digital extensors is on the dorsal proximal aspect of the middle phalanx [50]. Metacarpophalangeal joint extension is provided by extrinsic extensor force transmitted through the sagittal bands [50]. Distal interphalangeal joint extension is achieved through conjoined lateral bands composed of tendinous slips from extrinsic and intrinsic tendons [50]. The sagittal band fibers insert onto the volar proximal phalanx and onto the lateral borders of the volar plate [50]. The deep head of each dorsal interosseous muscle forms a lateral tendon, or lateral band, at the level of the MP joint [80]. Transverse fibers arch dorsally from each lateral band to join over the dorsum of the finger, flexing the proximal phalanx [80]. Oblique fibers from the lateral bands insert onto the lateral tubercles at the base of the middle phalanx to extend the middle phalanx at the PIP joint [80]. The lateral bands are joined by the lateral slips of the extensor tendon to form the conjoined lateral band [80]. 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 [80]. The relative motion concept harnesses normal functional anatomic relationships of the EDC and FDP muscles to vary forces on finger joints [106].

Flexor Mechanism

The flexor digitorum superficialis tendon bifurcates around the flexor digitorum profundus at the beginning of the A2 pulley [86]. It inserts via radial and ulnar slips into the proximal metaphysis of the middle phalanx [86]. The primary function of the flexor digitorum superficialis is digital flexion at the proximal interphalangeal joint [86]. The flexor digitorum profundus inserts on the proximal volar aspect of the distal phalanx [50]. The A2 and A4 pulleys are the most essential in maintaining the mechanical advantage of the flexor tendons [86]. The tenosynovium lining the fibroosseous tunnel supplies nutrition and lubrication to the poorly vascularized flexor tendons [86].

Soft Tissue & Skin

The dorsal skin of the hand is thin, possesses a normal pilosebaceous system, and has loose connections with deeper planes allowing free gliding [88]. Flexion of the fingers produces a significant lengthening of the dorsal skin, with an average increase of 3 cm in the middle finger from extension to full flexion [88]. The dorsal covering of the interphalangeal articulations forms a unique cutaneous unit characterized by a considerable excess of skin when the digits are in extension [79]. The volar plate is interconnected by the transverse interglenoid ligament [82]. The volar plates serve as the keystones of the longitudinal arches of the hand, preventing hyperextension at the metacarpophalangeal joints [82].

Pathophysiology

The pathogenesis of PIP joint contracture is attributed to a cycle of edema, immobilization, and tissue adherence of the capsuloligamentous structures [97]. PIP joint stiffness may result from traumatic and atraumatic conditions such as Dupuytren disease, infection, and neurological injury [97]. Boutonnière deformity results from a flexion deformity of the proximal interphalangeal joint and an extension deformity at the distal interphalangeal joint [157]. A positive Elson’s test is replicated by tensioning the extensor tendon after dividing the central slip while the PIP is maintained at 90 degrees of flexion, resulting in DIP joint extension [157]. Ultimate salvage for a failed PIP joint arthroplasty may require arthrodesis or even amputation [1]. If surgery for a volar PIP joint fracture-dislocation fails, a PIP arthrodesis will most likely need to be performed as a salvage procedure [70]. Potential complications of reverse hemi-hamate autograft for volar PIP joint fracture-dislocations include fixation failure, graft non-incorporation, loss of the extensor mechanism, and persistent instability [70]. Index finger PIP joint fusion is associated with impairment in the kinematics of precision pinch [21]. Simulated arthrodesis of the middle finger affected grip strength more than that of the ring finger [112].

Classification

Nalebuff: This system classifies boutonniere deformity into three stages based on the passive correctability of the PIP joint flexion deformity and the condition of the articular surfaces [77]. Stage 1 is characterized by synovitis of the PIP joint and a slight, fully correctable extensor lag [77]. Stage 2 consists of a marked flexion deformity of the PIP joint [77]. The deformity presents with a flexion posture of the PIP joint and a hyperextension posture of the DIP joint, and may be flexible or fixed [77].

Pathophysiology: The inciting event for boutonniere deformity is persistent synovitis of the PIP joint, which causes attenuation of the central slip, transverse retinacular ligaments, and triangular ligament [77]. Weakening of these structures leads to lateral bands subluxating volar to the axis of rotation of the PIP joint [77]. Lateral bands that subluxate volar to the axis of rotation become PIP joint flexors rather than extensors [77]. Persistence of PIP joint flexion leads to contraction of the volar plate, collateral ligaments, and oblique retinacular ligaments [77]. Contraction of these structures leads to a fixed contracture of the PIP joint [77].

Swan-Neck Deformity: The swan-neck deformity may be caused by abnormalities at the MCP, PIP, and occasionally DIP joints [77].

Weiss and Hastings: This classification describes condylar fractures of the metacarpal and proximal phalangeal heads according to whether the fracture involves one or both condyles and the direction of the fracture line in the sagittal, coronal, or transverse plane [163]. Class III fractures involve a dorsal coronal fragment [163]. Class IV fractures involve a palmar coronal fragment [163].

Other Considerations: Patients were considered for PIP joint arthroplasty if they had radiological signs of PIP joint osteoarthritis (Kellgren-Lawrence classification ≥grade 2) in combination with pain, despite nonsurgical treatment for at least 3 months [8].

Clinical Presentation

Chronic Arthropathy and Tendon Disorders

Patients with trigger finger may present with PIP joint pain that is mostly aching, felt on the palmar and dorsal aspect of the joint, and worsens with PIP joint movement, especially active extension [98]. This pain is often associated with long-standing trigger finger and a variable degree of fixed extension loss [98]. Patients with pre-existing PIP tenderness may sustain residual minor pain for up to 3 months after A1 pulley release for trigger finger [41].

PIP joint arthritis is an indication for arthroplasty when it causes invalidating functional pain [32]. Indications for PIP joint arthroplasty include radiological signs of osteoarthritis (Kellgren-Lawrence classification ≥grade 2) combined with pain despite nonsurgical treatment for at least 3 months [8]. Stiffness and deformity are additional indications for PIP joint surgery alongside pain [8]. PIP joint arthrodesis is a reliable method for restoring hand function in patients with arthritis and deformity of the PIP joints [66]. PIP joint stiffness remains an unsolved problem in hand surgery, with poor prognosis in complex cases even after complete arthrolysis and tenolysis [110].

Acute Injury and Instability

Patients with PIP joint sprains commonly experience a prolonged duration of swelling, stiffness, and dysfunction [128]. Initial symptoms of boutonniere deformity include swelling, pain, weakness, and a subjective feeling of PIP joint instability [126]. The Elson test distinguishes a central slip sprain from a disruption by assessing weak PIP joint extension and significant active DIP joint extension force with the PIP joint flexed [126].

Red-Flag Patterns

Patients with pyarthrosis of the small hand joints tend to present to their primary care provider when signs and symptoms of infection start, which is an average of 5 days after the inciting event [42]. Complications regularly arise after PIP joint injuries, yet they can often be prevented through early detection of injury and appropriate initial treatment protocols [11].

Investigations

Plain radiography: Radiological assessment identifies PIP joint osteoarthritis using the Kellgren-Lawrence classification. Patients are considered for PIP joint surgery when radiological signs indicate a Kellgren-Lawrence classification of grade 2 or higher, combined with pain that persists despite nonsurgical treatment for at least 3 months [8]. Stiffness and deformity serve as additional indications for PIP joint surgery alongside pain [8].

Other Considerations: Patients with inflammatory arthritis are excluded from PIP joint arthroplasty for osteoarthritis. This exclusion is based on the autoimmune nature of the disease, which is treated with medication and involves multiple joints in multiple body parts, potentially influencing the capability of performing work [8].

Pre-operative planning must account for the relationship between the PIP joint arthrodesis angle and DIP joint extension [33]. The Lister tubercle provides a bone graft with natural curvature that maintains finger length and positions the arthrodesis in flexion, satisfying the criteria for optimal PIP joint arthrodesis [67]. Regarding functional outcomes, no border digit PIP joint arthrodesis angle was superior for grip and pinch strength [173].

Treatment

Non-Operative

Conservative management includes passive manipulation as an alternative to surgical release for select PIP joint extension contractures [57]. External fixation serves as a simple and effective treatment modality for chronic traumatic PIP joint contractures, offering good predictable medium- to long-term results [40]. This approach is relatively simple and minimally invasive, rapidly reducing pain and swelling while restoring finger joint function [64]. While one to two grades of range of motion improvement can be achieved, deformity may persist even after dedicated conservative management [161]. For severe Dupuytren's PIPJ contracture, a simple staged procedure is a valid alternative, demonstrating reliable, reproducible correction and acceptable patient outcomes [27].

Operative

Indications: PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [9]. Surface replacement arthroplasty is indicated for primary degenerative or post-traumatic arthritis in elderly, less-active patients to maintain motion and avoid arthrodesis [68]. Silicone implant arthroplasty remains a common and generally successful surgery for correcting painful stiffness due to underlying arthropathy [72]. It remains a good option for pain relief in osteoarthritis [155]. Prosthetic replacement of digital joints in the rheumatoid hand is a reasonable and better alternative than either fusion or arthroplasty [140]. Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [31].

Surgical Approach / Technique: The procedure may be performed through various approaches with the PIP joint positioned in 20-30 degrees of flexion [3]. Insertion of a silicone implant arthroplasty can easily be performed through a lateral approach, affording early movement and few complications without leading to instability [113]. A study identified no statistical difference in mean postoperative ROM, incidence of complications, or revision surgery between volar and dorsal approaches for PIP arthroplasty [34]. For arthrodesis, methods include options for incisions, bone preparation techniques, and surgical implants, each with specific advantages and risks [105]. The "Pepper-Pot" arthrodesis technique is easy to perform, maintains digital length, and allows the surgeon to fine-tune the position of arthrodesis [122].

Implant Selection: Silicone arthroplasty provides generally reliable pain relief and patient satisfaction [72]. Excellent functional results and patient satisfaction can be gained using silastic PIP joint arthroplasty in the index finger [19]. Minimum 2 years of follow-up evaluation of the SLFJ implant demonstrated good pain relief and overall patient satisfaction while maintaining joint range of motion [20]. Surface replacement arthroplasty holds promise for the future, offering motion and stability for the index finger unattainable with silicone arthroplasty [22]. The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty [28]. RM Finger arthroplasty restores joint stability with active range of motion improvement and low pain, although it has a high rate of complications [162]. Pyrocarbon PIPJ arthroplasty carries a risk of early complications necessitating revision surgeries [45].

Arthrodesis Techniques: Available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes [4]. Risks of nonunion and reoperation are low, findings that guide preoperative decision-making and targeted postoperative surveillance [7]. Proximal interphalangeal joint arthrodesis using the tension band technique is a reliable method for restoring hand function in patients with arthritis and deformity [66]. Plate-augmented tension band wiring arthrodesis is an effective method, especially in the presence of osteopenia [63]. The use of SutureTape may provide equivalent biomechanical performance to steel wire, making it a viable alternative [125]. Augmenting 90/90 intraosseous wiring with 2 headless cannulated screws significantly increases stiffness in all directions as well as load to permanent deformation compared with wiring without cannulated screw augmentation [69].

Combined Procedures: Combining proximal interphalangeal joint arthroplasty with distal interphalangeal arthrodesis leads to 1-year outcomes similar to those achieved by proximal interphalangeal joint replacement alone [24]. Preliminary results encourage considering combining the two operations to increase range of motion following PIP joint arthroplasty, despite study limitations of small sample size and short follow-up [13]. Combined DIP arthrodesis and PIP procedures present unique challenges regarding hardware conflict; K-wires offer the easiest compatibility, while headless screws must ideally not reach proximal to the midpoint of the middle phalanx [36].

Other Considerations: Although most patients experienced significantly less pain after surgery, the pain reduction was considered clinically relevant in only 50% of patients [160]. 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 [6]. Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs [52]. Volar plate interposition arthroplasty may be a good therapeutic option for posttraumatic arthritis in PIP joints or MCP joints [5]. Ultimate salvage for the failed PIP joint arthroplasty may require arthrodesis or even amputation [1].

Complications

PIP Joint Arthroplasty

Implant Failure and Loosening: The most common complications of PIP joint arthroplasty include implant-related events such as loosening and fracture [143]. Newer resurfacing type PIP joint implants may show dislocation and implant loosening [150]. The rate of subsidence in surface replacement PIP joint arthroplasty remains unacceptably high [175]. Possible complications of PIP joint replacement include implant failure, joint stiffness, and joint deformity owing to instability [150].

Instability and Deformity: Recurrent deformities or instability are among the most common complications of PIP joint arthroplasty [143]. Potential complications of silicone PIP joint arthroplasty include the risk of lateral instability and recurrence of deformity due to the non-constrained implant design [142]. Postoperative dislocation was a cause of revision surgery in 6 cases of border digit PIP arthroplasty [141].

Stiffness and Pain: Stiffness and severe pain leading to reoperation are common complications of PIP joint arthroplasty [143]. The most common aetiologies for border digit PIP arthroplasty revision surgery were pain and stiffness [141]. Patients undergoing PIPJ arthroplasty should be advised that PIPJ ROM deteriorates over time [43].

Infection: Infection was a cause of revision surgery in 3 cases of border digit PIP arthroplasty [141].

Fracture: Implant fracture was a cause of revision surgery in 1 case of border digit PIP arthroplasty [141].

Other Considerations: Published complication rates range from 7% to 9% for silicone arthroplasties [143] and up to 30% for surface replacement arthroplasties [143]. Reoperation rates of 1% to 16% have been reported for silicone PIP joint arthroplasties [143], while reoperation rates of 6% to 58% have been reported for surface replacement PIP joint arthroplasties [143]. Approximately 1 in 3 PIP joint arthroplasties with a pyrocarbon implant will undergo more than 1 operation by 5 years [6]. Twenty-eight percent of patients undergoing pyrolytic carbon PIP joint arthroplasty required a second procedure [168], and eight percent required a revision arthroplasty [168]. Revision arthroplasty of the PIP joint was associated with a 70% 5-year survival [133] and a high incidence of complications [133]. Younger age leads to higher revision rates after PIP arthroplasty, particularly in the posttraumatic setting [71]. The most common complications of PIP joint arthroplasty also include synovitis [143] and bony changes at the implant-bone interface [143].

PIP Joint Arthrodesis

Other Considerations: Risks of nonunion and reoperation after PIPJ arthrodeses are low [7]. The available PIPJ arthrodesis techniques have similar complication rate outcomes [4]. Union was achieved primarily in 93.5 percent of cases with the use of Kirschner wire fixation alone for PIP joint arthrodesis in rheumatoid arthritis [178].

Salvage and Infection

Infection (PJI): Septic arthritis in small hand joints can develop from an adjacent infection that extends into the joint [42], from postoperative infection following non-joint surgery [42], or from hematogenous spread of infection [42]. Penetrating joint injury was the most common cause of septic arthritis in small hand joints, occurring in 73 patients [42]. Patients with small hand joint pyarthrosis tended to present to their primary care provider when signs and symptoms of infection started, which was an average of 5 days after the inciting event [42].

Recovery

Light activity (weeks): A controlled motion rehabilitation program for PIP joint arthroplasty guides occupational therapy over a twelve-week postoperative timeline [108]. This program promotes watchful progression to the timely achievement of optimal PIP joint motion while protecting the extensor tendon repair [108]. The volar approach for surface replacement arthroplasty allows early postoperative motion [12]. The hook plate technique for palmar fracture dislocation allows patients to tolerate early range of motion exercises [109].

Rehabilitation protocol: The controlled motion rehabilitation program for PIP joint arthroplasty guides occupational therapy over a twelve-week postoperative timeline [108]. This protocol promotes watchful progression to the timely achievement of optimal PIP joint motion while protecting the extensor tendon repair [108]. The simple staged procedure using a central slip facilitation device for severe Dupuytren's PIPJ contracture demonstrates reliable, reproducible correction of the deformity [27].

Functional milestones: The functional recovery after osteochondral autograft from the hamate for treating partial defect of the PIP joint is generally acceptable [44]. This recovery involves a well-restored joint architecture [44]. The simple staged procedure using a central slip facilitation device for severe Dupuytren's PIPJ contracture demonstrates acceptable patient outcomes [27].

Other Considerations: 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 [41]. Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients [23]. Findings on nonunion and reoperation risks can guide clinicians and patients in the preoperative decision-making process [7]. These findings can help with targeted postoperative surveillance to mitigate these risks [7]. The type of work and preoperative ability to perform work affect return to usual work following PIP joint arthroplasty for osteoarthritis [8]. Patients are considered for PIP joint arthroplasty if they have radiological signs of PIP joint osteoarthritis (Kellgren-Lawrence classification ≥grade 2) in combination with pain, despite nonsurgical treatment for at least 3 months [8]. Stiffness and deformity can be indications for PIP joint arthroplasty surgery [8]. Patients should be advised that PIPJ ROM deteriorates over time following pyrolytic carbon hemiarthroplasty [43]. The long-term outcomes of arthrodesis for severe recurrent PIP joint contractures in Dupuytren’s disease show high patient satisfaction [146]. These outcomes show fairly rapid return to function [146]. They also show no requirement for revision surgery [146]. Due to long-standing complex pathophysiological changes in boutonniere deformity, full correction may not be possible [25]. A few degrees of PIP joint extension deficit is inevitable in long-standing boutonniere deformity treated with FDS tendon transfer [25].

Key Evidence

• [L5] Ultimate salvage for the failed PIP joint arthroplasty may require arthrodesis or even amputation. [1] (10.1016/j.hcl.2017.12.011)
• [L4] Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause. [2] (10.1016/j.jhsa.2011.06.002)
• [L5] The procedure may be performed through various approaches with the PIP joint positioned in 20-30 degrees of flexion. [3] (10.1016/j.jhsa.2015.07.018)
• [L4] The available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes. [4] (10.1177/1558944721998019)
• [L4] We suggest that volar plate interposition arthroplasty may be a good therapeutic option for posttraumatic arthritis in PIP joints or MCP joints. [5] (10.1016/j.jhsa.2007.10.020)
• [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. [6] (10.1016/j.jhsa.2018.06.020)
• [L3] Risks of nonunion and reoperation after PIPJ arthrodeses are low; however, these findings may guide clinicians and patients in the preoperative decision-making process and help with targeted postoperative surveillance to mitigate these risks. [7] (10.1177/1558944720939196)
• [L3] [8] (10.1177/15589447221141485)
• [L4] PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. [9] (10.1177/17531934241265837)
• [L5] Complications regularly arise after PIP joint injuries, yet they can often be prevented through early detection of injury and appropriate initial treatment protocols. [11] (10.1016/j.hcl.2017.12.014)
• [L4] The volar approach offers the advantages of maintaining the integrity of the extensor mechanism and allowing early postoperative motion. [12] (10.1016/j.jhsa.2011.03.003)
• [L4] The authors state that their preliminary results encourage considering combining the two operations to increase range of motion following PIP joint arthroplasty, despite study limitations of small sample size and short follow-up. [13] (10.1177/1753193420954371)
• [L4] Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws, allowing early active range of motion and providing good objective and subjective outcomes, although noteworthy complications occurred in 39% of patients. [15] (10.1016/j.jhsa.2011.08.030)
• [L4] Although achieving solid fusion with arthrodesis is not completely reliable or without complication, patients' subjective and functional outcomes demonstrate fair to good results. [17] (10.1016/j.jhsa.2010.10.030)
• [L4] The series shows that excellent functional results and patient satisfaction can be gained using silastic PIP joint arthroplasty in the index finger. [19] (10.1177/1558944720921468)
• [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. [20] (10.1177/1558944717726136)
• [L1] This study reports impairment in the kinematics of precision pinch associated with index finger PIP joint fusion. [21] (10.1016/j.jhsa.2011.09.010)
• [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. [22] (10.1016/j.jhsa.2008.06.008)
• [L4] Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients. [23] (10.1016/j.jhsa.2018.06.023)
• [L3] Combining proximal interphalangeal joint arthroplasty with distal interphalangeal arthrodesis leads to 1-year outcomes that are similar to those achieved by proximal interphalangeal joint replacement alone. [24] (10.1177/17531934231191255)
• [L4] Due to long-standing complex pathophysiological changes, full correction may not be possible, and a few degrees of PIP joint extension deficit is inevitable. [25] (10.1016/j.otsr.2021.102971)
• [L4] The combination of DIP arthrodesis and PIP Swanson arthroplasty resulted in a favourable outcome in terms of simultaneous bony union and flexibility. [26] (10.1177/17531934231215790)
• [L4] The simple staged procedure is a valid alternative in the management of severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes. [27] (10.1177/1753193412439673)
• [L4] The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint. [28] (10.1177/1753193420977244)
• [L1] Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. [31] (10.1177/1558944718791186)
• [L4] It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain. [32] (10.1177/15589447211030962)
• [L5] The PIP joint arthrodesis angle affects DIP joint extension. [33] (10.1016/j.jhsa.2017.04.002)
• [L3] The study identified no statistical difference in mean postoperative ROM, incidence of complications, or revision surgery between volar and dorsal approaches for PIP arthroplasty. [34] (10.1177/1558944719861718)
• [L4] Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis. [35] (10.1016/j.jhsa.2014.12.016)
• [L5] Combined DIP arthrodesis and PIP procedures present unique challenges regarding hardware conflict; K-wires offer the easiest compatibility, while headless screws must ideally not reach proximal to the midpoint of the middle phalanx. [36] (10.1016/j.jhsa.2024.08.006)
• [L4] External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results. [40] (10.1016/j.jhsa.2013.07.007)
• [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. [41] (10.1186/s12891-023-06130-5)
• [L3] [42] (10.1016/j.jhsa.2011.05.022)
• [L4] Patients should be advised that PIPJ ROM deteriorates over time. [43] (10.1016/j.jhsa.2023.11.007)
• [L4] The functional recovery is generally acceptable, with a well-restored joint architecture. [44] (10.1016/j.jhsa.2021.11.007)
• [L3] Pyrocarbon PIPJ arthroplasty has a risk of early complications necessitating revision surgeries. [45] (10.1007/s00402-020-03592-3)
• [L3] Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs. [52] (10.1016/j.jhsa.2019.11.002)
• [L4] Passive manipulation is an alternative to surgical release for select PIP joint extension contractures. [57] (10.1016/j.jhsa.2022.01.023)
• [L4] Plate-augmented tension band wiring arthrodesis for fusion of the MCP and PIP joints is an effective method, especially in the presence of osteopenia. [63] (10.1177/1753193421991762)
• [L4] It is a relatively simple and minimally invasive procedure that can rapidly reduce pain, and swelling, and restore finger joint function. [64] (10.1186/s13018-025-05893-y)
• [L5] Proximal interphalangeal joint arthrodesis using the tension band technique is a reliable method for restoring hand function in patients with arthritis and deformity of the PIP joints. [66] (10.1016/j.jhsa.2007.04.014)
• [L4] The Lister tubercle provides a bone graft with natural curvature that maintains finger length and positions the arthrodesis in flexion, satisfying the criteria for optimal PIP joint arthrodesis. [67] (10.1016/j.jhsa.2012.05.043)
• [L4] Surface replacement arthroplasty of the PIPJ is indicated for primary degenerative or post-traumatic arthritis in elderly, less-active patients to maintain motion and avoid arthrodesis. [68] (10.1016/j.jhsa.2007.04.012)
• [L5] Augmenting 90/90 intraosseous wiring for PIP joint arthrodesis with 2 headless cannulated screws significantly increases stiffness in all directions as well as load to permanent deformation compared with 90/90 intraosseous wiring without cannulated screw augmentation. [69] (10.1016/j.jhsa.2018.04.010)
• [L4] [70] (10.1016/j.jhsa.2023.01.009)
• [L3] Younger age leads higher revision rates after PIP arthroplasty, particularly in the posttraumatic setting. [71] (10.5435/jaaos-d-17-00109)
• [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. [72] (10.1016/j.jhsa.2007.04.013)
• [L5] [77] (10.5435/00124635-199903000-00002)
• [L4] The patterns of peri-articular finger injuries differ greatly between the three finger joints, explained by the mechanism of falling and local biomechanical forces. [92] (10.1177/17531934251381203)
• [L5] Proper biomechanics of a joint must be restored to achieve full, functional range of motion. [94] (10.1016/j.hcl.2017.12.008)
• [L5] [97] (10.1016/j.jhsa.2015.06.118)
• [L4] [98] (10.1177/1753193418809771)
• [L4] The third toe proximal phalanx distal articular surface more closely matched the geometric characteristics of the finger proximal phalanx distal articular surface than did the toe middle phalanx distal articular surface. [102] (10.1016/j.jhsa.2011.01.047)
• [L5] [105] (10.5435/jaaos-d-15-00033)
• [L5] The relative motion concept harnesses normal functional anatomic relationships of the EDC and FDP muscles to vary forces on finger joints, allowing immediate controlled active motion while reducing undesirable tension. [106] (10.1016/j.jht.2022.12.006)
• [L5] This controlled motion rehabilitation program has been useful in our practice to help guide occupational therapy over a twelve-week postoperative timeline in a manner that is simple and promotes watchful progression to the timely achievement of optimal PIP joint motion while protecting the extensor tendon repair. [108] (10.1016/j.jht.2019.04.003)
• [L4] The hook plate technique, which minimizes interference with the finger extension mechanism, is an effective surgical procedure that allows patients to tolerate early range of motion exercises and obtain satisfactory clinical outcomes in both the PIP and DIP joints. [109] (10.1016/j.jhsa.2023.09.004)
• [L5] PIP joint stiffness remains an unsolved problem in hand surgery, with poor prognosis in complex cases even after complete arthrolysis and tenolysis. [110] (10.1177/17531934221143690)
• [L4] Simulated arthrodesis of the middle finger affected the grip strength more than that of the ring finger. [112] (10.1007/s00402-021-04317-w)
• [L4] Insertion of a silicone implant arthroplasty for the PIP joint can easily be performed through a lateral approach, affording early movement and few complications without leading to instability. [113] (10.1016/j.jhsa.2007.04.011)
• [L4] The technique is easy to perform, maintains digital length, and allows the surgeon to fine-tune the position of arthrodesis, with fusion rates comparable to previously described techniques. [122] (10.1054/jhsb.2002.0798)
• [L5] The use of SutureTape for MCP and PIP joint arthrodesis may provide equivalent biomechanical performance to that of steel wire, making it a viable alternative clinically. [125] (10.1016/j.jhsg.2024.08.014)
• [L4] [126] (10.1016/j.jht.2023.02.005)
• [L4] It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. [128] (10.1016/j.jhsa.2023.01.025)
• [L3] Revision arthroplasty was associated with a 70% 5-year survival but with a high incidence of complications. [133] (10.1016/j.jhsa.2015.05.015)
• [L4] [141] (10.1177/1753193420926127)
• [L4] [142] (10.1177/17531934231156073)
• [L1] [143] (10.1177/1753193418770606)
• [L4] The long-term outcomes show high patient satisfaction, fairly rapid return to function with no requirement for revision surgery. [146] (10.1177/1753193420960309)
• [L4] [150] (10.1177/1753193413511922)
• [L4] Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. [155] (10.1177/1558944718769427)
• [L5] [157] (10.1186/s13018-025-06329-3)
• [L5] The use of external fixation for treating PIP contracture has been encouraging and can be a useful alternative. [159] (10.1016/j.jhsa.2013.03.014)
• [L4] Although most patients experienced significantly less pain after surgery, the pain reduction was considered clinically relevant in only 50% of patients. [160] (10.1016/j.jhsa.2022.03.026)
• [L3] One to two grades of ROM improvement can be achieved, although deformity can persist even after dedicated conservative management. [161] (10.1016/j.jht.2025.02.013)
• [L4] RM Finger arthroplasty of the PIP joint restores joint stability with AROM improvement and low pain, although it has a high rate of complications. [162] (10.1007/s00402-017-2725-8)
• [L4] [163] (10.1016/j.jhsa.2010.12.004)
• [L4] Twenty-eight percent of patients required a second procedure and 8% required a revision arthroplasty. [168] (10.1016/j.jhsa.2006.10.017)
• [L4] No border digit PIP joint arthrodesis angle was superior for grip and pinch strength. [173] (10.1016/j.jhsa.2019.11.008)
• [L4] The rate of subsidence improved but remains unacceptably high. [175] (10.1177/1558944718760035)
• [L4] Union was achieved primarily in 93.5 percent of cases with the use of Kirschner wire fixation alone. [178] (10.3109/17453676608989418)

See Also

• PIP Joint Replacement
• Boutonnière Deformity
• Dislocations
• Trigger Finger
• PIP Joint Arthritis
• Joint Surgery
• Extensor Tendon Repair

References

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