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PIP joint replacement

Surgeon-side topic for pip joint replacement. Backed by 354 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Proximal interphalangeal (PIP) joint arthroplasty serves as a viable option for pain relief and motion restoration in osteoarthritis, with surface replacement arthroplasty offering stability and range of motion for the index finger unattainable with silicone arthroplasty [6]. While silastic PIP joint arthroplasty remains a good option for pain relief in osteoarthritis [15] and yields excellent functional results in the index finger [14], treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [2]. Patients typically return to work after a median of 8 weeks following the procedure [1].

Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3]. Implant-specific data indicates that 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 [4]. Conversely, the CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty [5], and the SR PIP implant continues to be an option for patients with osteoarthritis of the PIP joint [21].

Preliminary results encourage considering concomitant arthrodesis of the distal interphalangeal joint with surface replacement arthroplasty of the proximal interphalangeal joint to increase range of motion [13]. The minimum 2-year follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief, good overall patient satisfaction, and maintenance of joint range of motion [10]. Minimizing postoperative complications after MCP and PIP joint arthroplasty remains a key avenue to decrease health care costs [8].

Anatomy & Pathophysiology

Osseous and Articular Morphology

Thumb basal joint arthritis represents a progressive disease where new biomechanical and longitudinal clinical studies are altering prevailing opinions on serial degenerative changes [27]. The third toe proximal phalanx distal articular surface more closely matches the geometric characteristics of the finger proximal phalanx distal articular surface than does the toe middle phalanx distal articular surface [40]. There is no universal or typical load distribution pattern of the hand; rather, only an individual pattern exists [38]. In children and adolescents aged 0 to 19 years, thumbs were typically straight, whereas the index and middle fingers deviated ulnarly, and ring and little fingers radially [33].

Kinematics and Biomechanics

Patterns of peri-articular finger injuries differ greatly between the three finger joints, explained by the mechanism of falling and local biomechanical forces [26]. Passive interphalangeal joint motion varies with wrist positions when treating thumb flexor tendon injuries, with benefits seen primarily for wrist extension [28]. Mean forearm shortening of 3 or 4 cm resulted in near-complete loss of flexor digitorum profundus simulated muscle force and tip-to-palm force in wrist-neutral and wrist-extension positions, respectively [29]. Clear patterns of motion loss are associated with isolated simulated adhesions in different locations along the extensor mechanism [39]. A novel proximal interphalangeal joint implant design using a rolling contact joint mechanism demonstrated acceptable outcomes in terms of proximal interphalangeal joint human kinematics and tendon excursions [37].

Ligamentous, Tendon, and Soft Tissue Dynamics

The relative motion concept harnesses normal functional anatomic relationships of the extensor digitorum communis and flexor digitorum profundus muscles to vary forces on finger joints, allowing immediate controlled active motion while reducing undesirable tension [45]. Minimally invasive and percutaneous techniques can effectively release several structures known to cause finger stiffness with minimal damage to surrounding structures [44]. Stiffness of the proximal interphalangeal joint is a challenging problem that may be successfully treated under the guidance of a hand therapist [32]. Immobilization of the distal interphalangeal joint of any finger reduces the overall grip strength of the hand, with the effect becoming progressively more pronounced from the index to the little fingers [49].

Vascular and Neural Considerations

Wrist deviation from neutral can lead to more pronounced deformation of the median nerve than finger flexion for both intensive and nonintensive electronic device users [31].

Surgical Outcomes and Measurement

Both volar plating and external fixation can obtain a good range of motion at the proximal interphalangeal joint for unstable dorsal fracture-dislocations [42]. The nonaxial multiple small screws technique showed biomechanical stability comparable to that of the axial headless compression screw technique in distal interphalangeal joint and thumb interphalangeal joint arthrodesis [41]. Implant fractures following silicone metacarpophalangeal joint arthroplasty in rheumatoid arthritis did not significantly affect upper limb function [47]. Photogoniometry is not an acceptable alternative to manual goniometry for determining wrist and digit range of motion in general [43].

Classification

Proposed PIP-Kellgren functional-radiological classification: This system stratifies surgical candidates and standardizes severity assessment for PIP joint pathology [25].

Other Considerations: Indications and Contraindications: PIPJ implant arthroplasty is a good and reliable option for symptomatic degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [7]. Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [2]. Implant Selection: Surface replacement arthroplasty of the PIP joint offers motion and stability for the index finger unattainable with silicone arthroplasty [6]. The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint [5]. Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the PIP joint [21]. Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis [22]. Excellent functional results and patient satisfaction can be gained using silastic PIP joint arthroplasty in the index finger [14]. Outcomes and Complications: Patients returned to work after a median of 8 weeks following PIP arthroplasty [1]. Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3]. Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years [4]. Approximately 1 in 3 PIP joint arthroplasties with a pyrocarbon implant will undergo more than 1 operation [4]. Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [9]. Procedural Adjuncts: The Superficialis Sling procedure may be performed with the PIP joint positioned in 20-30 degrees of flexion [11]. Anatomical findings provide a basis for procedures to denervate the PIP joint [24]. Trends: There has been an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased [16].

Clinical Presentation

Patients presenting for PIP joint arthroplasty typically exhibit symptomatic degenerative, post-traumatic, or inflammatory arthritis [7]. Indication: The procedure is a good and reliable option given the proper clinical setting [7], though treatment of the long finger may be a relative contraindication [2]. Implant Selection: Surface replacement arthroplasty offers motion and stability for the index finger unattainable with silicone arthroplasty [6], while the CapFlex-PIP implant demonstrates favourable medium-term results [5]. Timing: Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture when deciding on surgery timing [35].

Postoperative Expectations: Patients returned to work after a median of 8 weeks [1]. Those with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months [19]. Prolonged swelling, stiffness, and dysfunction are common following PIP joint sprains [36]. Revision Risk: Approximately 1 in 5 pyrocarbon implants require revision by 5 years, and approximately 1 in 3 undergo more than one operation [4]. Reoperations following primary nonconstrained arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3].

Outcomes by Implant Type: Silicone implant arthroplasty remains a common and generally successful surgery for painful stiffness due to arthropathy, providing reliable pain relief and patient satisfaction [17]. It can be performed through a lateral approach, affording early movement and few complications without instability [12]. Excellent functional results are gained using silastic arthroplasty in the index finger [14], and it remains a good option for osteoarthritis pain relief [15]. The SLFJ implant demonstrated good pain relief and satisfaction while maintaining range of motion at 2 years [10]. An anatomically neutral implant provides reliable, long-term pain relief and function maintenance for MCP and PIP osteoarthritis [18]. Specific Indications: The TACTYS prosthesis should be proposed exceptionally if arthritis causes invalidating functional pain [30]. Simultaneous surgical intervention is recommended for severe painful OA of the PIP and DIP joints of the same digit [34].

Complications: Minimizing postoperative complications after MCP and PIP arthroplasty is a key avenue to decrease healthcare costs [8]. Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [9].

Investigations

Plain radiography: The proposed PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment [25]. Radiological osteoarthritis after a metacarpal fracture fixation (MFF) is similar to the natural degenerative process in the distal interphalangeal (DIP) joint and is accompanied by a decrease in range of motion of the DIP joint [54]. Post-operative imaging confirms that a pyrocarbon prosthesis replacing the proximal interphalangeal joint reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed [53].

Other Considerations: PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting [7]. Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [2]. 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 [17]. Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief [15]. Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [18]. The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint [5]. Surface replacement arthroplasty of the PIP joint offers motion and stability for the index finger unattainable with silicone arthroplasty [6]. Combining concomitant arthrodesis of the distal interphalangeal joint with surface replacement arthroplasty of the proximal interphalangeal joint may increase range of motion following PIP joint arthroplasty [13].

Prognosis and Complications: Patients returned to work after a median of 8 weeks following PIP arthroplasty [1]. Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [9]. Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3]. Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years [4]. Approximately 1 in 3 PIP joint arthroplasties with a pyrocarbon implant will undergo more than 1 operation [4]. Risks of nonunion and reoperation after PIPJ arthrodeses are low [58]. There has been an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased [16].

Treatment

Non-Operative

Conservative management is implied as a prerequisite for surgical intervention, though specific non-operative modalities are not detailed in the provided evidence base.

Operative

Indications: PIPJ implant arthroplasty is a good and reliable option for symptomatic degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [7]. Surface replacement arthroplasty is specifically indicated for primary degenerative or post-traumatic arthritis in elderly, less-active patients to maintain motion and avoid arthrodesis [20]. Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [2]. Patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after surgery [19].

Surgical Approach / Technique: There is no statistical difference in mean postoperative ROM, incidence of complications, or revision surgery between volar and dorsal approaches for PIP arthroplasty [23]. 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 [12]. The superficialis sling procedure may be performed through various approaches with the PIP joint positioned in 20-30 degrees of flexion [11]. Passive manipulation is an alternative to surgical release for select PIP joint extension contractures [51].

Implant Selection: Surface replacement arthroplasty of the PIP joint offers motion and stability for the index finger unattainable with silicone arthroplasty [6]. Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief [15] and 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 [17]. The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint [5]. Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the PIP joint [21]. Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis [22]. The Ascension pyrocarbon PIP joint replacement is an effective and reliable treatment for the painful, mobile arthritic PIP joint, maintaining useful motion and providing effective pain relief [52]. Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [18].

Adjuncts: Combining concomitant arthrodesis of the distal interphalangeal joint with surface replacement arthroplasty of the proximal interphalangeal joint may increase range of motion following PIP joint arthroplasty [13]. Findings on the innervation of the proximal interphalangeal joint provide an anatomical basis for procedures to denervate the PIP joint [24].

Revision: Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [3]. Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years [4]. Approximately 1 in 3 PIP joint arthroplasties with a pyrocarbon implant will undergo more than 1 operation [4]. Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs [8]. Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [9].

Other Considerations: Patients returned to work after a median of 8 weeks following PIP arthroplasty [1]. 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 [10].

Complications

Extensor-mechanism dysfunction: This is the most frequent cause of reoperation following primary nonconstrained PIP joint arthroplasty [3]. Reoperations are common in this setting [3], with approximately 1 in 3 pyrocarbon implants undergoing more than one operation and 1 in 5 requiring revision surgery by 5 years [4]. Revision arthroplasty is associated with a 70% 5-year survival rate but carries a high incidence of complications [59].

Infection (PJI): Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [9]. Minimizing postoperative complications after these procedures is a key avenue to decrease health care costs [8].

Other Considerations: Patients typically return to work after a median of 8 weeks [1]. Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [2]. A total of 13% of joints required a secondary surgical procedure [62]. Major complications occurred at roughly half the rate in the staged group compared to the single-stage group for severe PIPJ contractures in Dupuytren disease, although the study was underpowered for complication analysis [63]. Proximal interphalangeal joint arthroplasty performed on multiple digits results in no worse outcomes compared with single digit arthroplasty, with similar rates of complications, reoperation, and revision surgery [64]. There is no statistical difference in mean postoperative ROM, incidence of complications, or revision surgery between volar and dorsal approaches [23]. Surface replacement arthroplasty offers motion and stability for the index finger unattainable with silicone arthroplasty [6]. The CapFlex-PIP implant demonstrates favourable medium-term results [5], and the SLFJ implant demonstrated good pain relief, satisfaction, and maintained ROM at minimum 2 years of follow-up [10]. PIPJ implant arthroplasty is a good and reliable option for symptomatic degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [7]. Surface replacement is indicated for primary degenerative or post-traumatic arthritis in elderly, less-active patients to maintain motion and avoid arthrodesis [20]. Data demonstrate increased use of primary PIPA for OA, whereas revision PIPA decreased [16]. Longer follow-up and prospective randomized comparisons are needed to better define rates of revision, failure, and complications [60].

Recovery

Light activity (weeks): Patients typically return to work after a median of 8 weeks following PIP arthroplasty [1]. A controlled motion rehabilitation program has been useful to guide occupational therapy over a twelve-week postoperative timeline [46]. This protocol promotes watchful progression to the timely achievement of optimal PIP joint motion while protecting the extensor tendon repair [46]. Patients with pre-existing PIP tenderness should be informed about the possibility of sustaining residual minor pain for up to 3 months after surgery [19].

Full activity (months): Surface replacement arthroplasty of the PIP joint offers motion and stability for the index finger unattainable with silicone arthroplasty [6]. Combining concomitant arthrodesis of the distal interphalangeal joint with surface replacement arthroplasty of the proximal interphalangeal joint may increase range of motion following PIP joint arthroplasty [13]. Excellent functional results and patient satisfaction can be gained using silastic PIP joint arthroplasty in the index finger [14].

Complete recovery / outcome plateau (months): The minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief, good overall patient satisfaction, and maintenance of joint range of motion [10]. Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years [4]. Approximately 1 in 3 PIP joint arthroplasties with a pyrocarbon implant will undergo more than 1 operation [4]. Reoperations following primary nonconstrained PIP joint arthroplasties are common [3], with extensor mechanism dysfunction being the most frequent cause [3].

Rehabilitation protocol: Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs [8]. Insertion of a silicone implant arthroplasty for the PIP joint can easily be performed through a lateral approach [12]. A lateral approach for PIP joint silicone implant arthroplasty affords early movement and few complications without leading to instability [12]. The superficialis sling procedure may be performed with the PIP joint positioned in 20-30 degrees of flexion [11].

Functional milestones: The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint [5]. Long-term outcomes of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren's disease show high patient satisfaction, fairly rapid return to function, and no requirement for revision surgery [50]. 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 [56]. Functional recovery following osteochondral autograft from the hamate for treating partial defect of the proximal interphalangeal joint is generally acceptable [57]. Osteochondral autograft from the hamate for treating partial defect of the proximal interphalangeal joint results in well-restored joint architecture [57]. The arc during which the defect in the head of P1 engages the base of P2 is almost entirely outside the functional ROM of the PIP joint [61].

Other Considerations: Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [2]. Surface replacement arthroplasty of the PIPJ is indicated for primary degenerative or post-traumatic arthritis in elderly, less-active patients [20]. Surface replacement arthroplasty of the PIPJ is indicated to maintain motion and avoid arthrodesis [20]. There has been an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased [16].

Key Evidence

  • [L3] Patients returned to work after a median of 8 weeks following PIP arthroplasty. (10.1177/15589447221141485)
  • [L1] Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. (10.1177/1558944718791186)
  • [L4] Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause. (10.1016/j.jhsa.2011.06.002)
  • [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. (10.1016/j.jhsa.2018.06.020)
  • [L4] The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint. (10.1177/1753193420977244)
  • [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. (10.1016/j.jhsa.2008.06.008)
  • [L4] PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. (10.1177/17531934241265837)
  • [L3] Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs. (10.1016/j.jhsa.2019.11.002)
  • [L4] PJI is uncommon after MCP or PIP arthroplasties. (10.1016/j.jhsa.2024.12.008)
  • [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. (10.1177/1558944717726136)
  • [L5] The procedure may be performed through various approaches with the PIP joint positioned in 20-30 degrees of flexion. (10.1016/j.jhsa.2015.07.018)
  • [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. (10.1016/j.jhsa.2007.04.011)
  • [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. (10.1177/1753193420954371)
  • [L4] The series shows that excellent functional results and patient satisfaction can be gained using silastic PIP joint arthroplasty in the index finger. (10.1177/1558944720921468)
  • [L4] Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. (10.1177/1558944718769427)
  • [L4] The data demonstrate an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased. (10.1177/1558944719837009)
  • [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. (10.1016/j.jhsa.2007.04.013)
  • [L4] Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function. (10.1016/j.jhsa.2008.11.005)
  • [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. (10.1186/s12891-023-06130-5)
  • [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. (10.1016/j.jhsa.2007.04.012)
  • [L4] Surface replacement arthroplasty using the SR PIP implant continues to be an option for patients with osteoarthritis of the PIP joint. (10.1016/j.jhsa.2014.11.015)
  • [L4] Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis. (10.1016/j.jhsa.2014.12.016)
  • [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. (10.1177/1558944719861718)
  • [L5] These findings provide an anatomical basis for procedures to denervate the PIP joint. (10.1016/j.jhsa.2018.07.014)
  • [L4] The proposed PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment. (10.1016/j.jhsg.2025.100911)
  • [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. (10.1177/17531934251381203)
  • [L5] Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes. (10.5435/jaaos-d-17-00374)
  • [L5] This study provides a mechanistic rationale for passive interphalangeal joint motion in varying wrist positions when treating thumb flexor tendon injuries, with benefits seen primarily for wrist extension. (10.1016/j.jht.2019.01.005)
  • [L5] Mean forearm shortening of 3 or 4 cm resulted in near-complete loss of FDP simulated muscle force and tip-to-palm force in wrist-neutral and wrist-extension positions, respectively. (10.1016/j.jhsa.2024.09.005)
  • [L4] It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain. (10.1177/15589447211030962)
  • [L4] Wrist deviation from neutral can lead to more pronounced deformation of the median nerve than finger flexion for both intensive and nonintensive users. (10.1016/j.jhsa.2018.08.006)
  • [L5] Stiffness of the PIP joint is a challenging problem that may be successfully treated under the guidance of a hand therapist. (10.1016/j.jhsa.2015.06.118)
  • [L4] Thumbs were typically straight, whereas the index and middle fingers deviated ulnarly, and ring and little fingers radially. (10.1177/1753193420986122)
  • [L3] The authors recommend simultaneous surgical intervention in case of severe painful OA of the PIP and DIP joints of the same digit. (10.1177/17531934231191255)
  • [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. (10.1016/j.jhsa.2018.06.023)
  • [L4] It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. (10.1016/j.jhsa.2023.01.025)
  • [L5] A novel PIPJ implant design using an RCJ mechanism demonstrated acceptable outcomes in terms of PIPJ human kinematics and tendon excursions. (10.1186/s13018-019-1234-6)
  • [L2] There is no universal or typical load distribution pattern of the hand but only an individual pattern. (10.1016/j.jht.2016.10.009)
  • [L5] The results of this study identified clear patterns of motion loss that are associated with isolated simulated adhesions in different locations along the extensor mechanism. (10.1016/j.jhsa.2018.12.011)
  • [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. (10.1016/j.jhsa.2011.01.047)
  • [L4] The NMSS technique showed biomechanical stability comparable to that of the AHCS technique in DIPJ and thumb IPJ arthrodesis. (10.1186/s12891-022-05473-9)
  • [L4] Both methods can obtain a good range of motion at the proximal interphalangeal joint. (10.1177/17531934211059300)
  • [L4] At present, photogoniometry is not an acceptable alternative to manual goniometry for determining wrist and digit range of motion in general. (10.1177/1558944717702471)
  • [L5] Minimally invasive and percutaneous techniques can effectively release several structures known to cause finger stiffness with minimal damage to surrounding structures. (10.1016/j.jhsa.2019.01.006)
  • [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. (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. (10.1016/j.jht.2019.04.003)
  • [L4] However, implant fractures did not significantly affect upper limb function. (10.1016/j.jhsa.2024.01.009)
  • [L4] Immobilization of the distal interphalangeal joint of any finger reduces the overall grip strength of the hand, with the effect becoming progressively more pronounced from the index to the little fingers. (10.1177/1753193418765068)
  • [L4] The long-term outcomes show high patient satisfaction, fairly rapid return to function with no requirement for revision surgery. (10.1177/1753193420960309)
  • [L4] Passive manipulation is an alternative to surgical release for select PIP joint extension contractures. (10.1016/j.jhsa.2022.01.023)
  • [L4] The Ascension pyrocarbon PIP joint replacement is an effective and reliable treatment for the painful, mobile arthritic PIP joint, maintaining useful motion and providing effective pain relief. (10.1177/1753193414566552)
  • [L4] The study reports good pain relief and stable radiographic integration at 5 years, with no late revisions or loosening observed, despite no improvement in range of motion. (10.1177/1753193413479527)
  • [L4] Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. (10.1016/j.jhsa.2023.03.027)
  • [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. (10.1016/j.jhsa.2011.03.003)
  • [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. (10.1186/s12891-020-03310-5)
  • [L4] The functional recovery is generally acceptable, with a well-restored joint architecture. (10.1016/j.jhsa.2021.11.007)
  • [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. (10.1177/1558944720939196)
  • [L3] Revision arthroplasty was associated with a 70% 5-year survival but with a high incidence of complications. (10.1016/j.jhsa.2015.05.015)
  • [L4] Longer follow-up and prospective randomized comparisons are needed to better define rates of revision, failure, and complications. (10.1016/j.jhsa.2010.04.005)
  • [L5] The arc during which the defect in the head of P1 engages the base of the P2 is almost entirely outside the functional ROM of the PIP joint. (10.1016/j.jhsa.2023.11.014)
  • [L4] A total of 13% of the joints required a secondary surgical procedure. (10.1016/j.jhsa.2009.08.010)
  • [L3] Major complications occurred at roughly half the rate in the staged group, suggesting a potential safety advantage, although the study was underpowered for complication analysis. (10.1016/j.jhsa.2025.10.019)
  • [L4] Proximal interphalangeal joint arthroplasty performed on multiple digits results in no worse outcomes compared with single digit proximal interphalangeal joint arthroplasty, with similar rates of complications, reoperation, and revision surgery. (10.1177/1753193418765691)

See Also

References

[1] 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

[2] 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

[3] Reoperations Following Proximal Interphalangeal Joint Nonconstrained Arthroplasties. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.06.002

[4] 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

[5] 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

[6] 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

[7] Proximal interphalangeal joint arthroplasty: current trends and evidence-based practice. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241265837

[8] 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

[9] 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

[10] 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

[11] Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.07.018

[12] Lateral Approach to Proximal Interphalangeal Joint Implant Arthroplasty. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.04.011

[13] Concomitant arthrodesis of the distal interphalangeal joint with surface replacement arthroplasty of the proximal interphalangeal joint: a comparative study in 11 patients. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420954371

[14] The Long-term Results of Proximal Interphalangeal Joint Arthroplasty of the Osteoarthritic Index Finger. HAND. 2020. DOI: 10.1177/1558944720921468

[15] Proximal Interphalangeal Joint Silicone Arthroplasty for Osteoarthritis: Midterm Outcomes. HAND. 2018. DOI: 10.1177/1558944718769427

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

[17] The Dorsal Approach to Silicone Implant Arthroplasty of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.04.013

[18] Anatomically Neutral Silicone Small Joint Arthroplasty for Osteoarthritis. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.11.005

[19] Dorsal proximal interphalangeal joint tenderness is associated with prolonged postoperative pain after A1 pulley release for trigger fingers. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06130-5

[20] Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.04.012

[21] Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint Using the SR PIP Implant: Long-Term Results. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.11.015

[22] 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

[23] Comparison of Volar and Dorsal Approach for PIP Arthroplasty. HAND. 2019. DOI: 10.1177/1558944719861718

[24] Innervation of the Proximal Interphalangeal Joint: An Anatomical Study. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.07.014

[25] 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

[26] Is there a difference in the types of injuries occurring around each finger joint after a fall?. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251381203

[27] Thumb Basal Joint Arthritis. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00374

[28] Calculation of flexor pollicis longus moment arm for wrist motion in a cadaver model validates the tenodesis effect for therapy. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2019.01.005

[29] The Effect of Forearm Shortening on Finger Flexion: A Biomechanical Study. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.005

[30] Arthroplasty of the Proximal Interphalangeal Joint With the TACTYS Prosthesis: Clinical and Radiographic Results With a Mean Follow-up of 5 Years. HAND. 2022. DOI: 10.1177/15589447211030962

[31] Morphological Changes of the Median Nerve Within the Carpal Tunnel During Various Finger and Wrist Positions: An Analysis of Intensive and Nonintensive Electronic Device Users. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.08.006

[32] Hand Therapy Modalities for Proximal Interphalangeal Joint Stiffness. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.118

[33] Radioulnar interphalangeal joint angles in children and adolescents aged 0 to 19 years. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193420986122

[34] Does distal interphalangeal joint arthrodesis affect proximal interphalangeal joint arthroplasty outcomes in the same finger?. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231191255

[35] Factors Causing Prolonged Postoperative Symptoms Despite Absence of Complications After A1 Pulley Release for Trigger Finger. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.023

[36] Swelling, Stiffness, and Dysfunction Following Proximal Interphalangeal Joint Sprains. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.01.025

[37] Novel implant design of the proximal interphalangeal joint using an optimized rolling contact joint mechanism. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1234-6

[38] Load distribution of the hand during cylinder grip analyzed by Manugraphy. Journal of Hand Therapy. 2017. DOI: 10.1016/j.jht.2016.10.009

[39] The Effect of Extensor Tendon Adhesions on Finger Motion. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.12.011

[40] Structural Comparison of the Finger Proximal Interphalangeal Joint Surfaces and Those of the Third Toe: Suitability for Joint Reconstruction. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.01.047

[41] Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05473-9

[42] Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211059300

[43] Viability of Hand and Wrist Photogoniometry. HAND. 2017. DOI: 10.1177/1558944717702471

[44] Percutaneous Release of the Finger Joints and Mini-Open Intrinsic Release With Tenolysis: A Cadaveric Study. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.01.006

[45] A commentary from the pioneers on the innovation of the relative motion concept: History, biologic considerations, and anatomic rationale. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2022.12.006

[46] A new controlled motion program for rehabilitation of the proximal interphalangeal joint arthroplasty. Journal of Hand Therapy. 2021. DOI: 10.1016/j.jht.2019.04.003

[47] Long-Term Implant Fracture Rates Following Silicone Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.01.009

[49] Effect of immobilization of the distal interphalangeal joint of fingers on grip strength. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418765068

[50] Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420960309

[51] Passive Manipulation for Proximal Interphalangeal Joint Extension Contractures. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.01.023

[52] Pyrocarbon proximal interphalangeal joint arthroplasty: a medium to long term follow-up of a single surgeon series. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193414566552

[53] Ten years’ experience with a pyrocarbon prosthesis replacing the proximal interphalangeal joint. A prospective clinical and radiographic follow-up. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413479527

[54] Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.03.027

[55] 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

[56] Reconstruction of finger joints using autologous rib perichondrium – an observational study at a single Centre with a median follow-up of 37 years. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03310-5

[57] Osteochondral Autograft From the Hamate for Treating Partial Defect of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.11.007

[58] Nonunion and Reoperation Following Proximal Interphalangeal Joint Arthrodesis and Associated Patient Factors. HAND. 2020. DOI: 10.1177/1558944720939196

[59] Revision Proximal Interphalangeal Arthroplasty: An Outcome Analysis of 75 Consecutive Cases. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.015

[60] Proximal Interphalangeal Joint Prosthetic Arthroplasty. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.04.005

[61] Articular Surface Involvement With Retrograde Headless Screw Fixation of the Proximal Phalanx. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.11.014

[62] Outcomes of Proximal Interphalangeal Joint Pyrocarbon Implants. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.08.010

[63] Single-Stage Versus Staged Fasciectomy for Severe PIPJ Contractures in Dupuytren Disease: A Retrospective Comparative Study. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.10.019

[64] Impact of multi- versus single finger proximal interphalangeal joint arthroplasty: analysis of 249 fingers treated in 15 years. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418765691

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