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近端指间关节关节炎

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

Updated Aug 2026
一幅手绘插图，展示了一个磨损的关节炎中指关节。
受关节炎影响的手——手指关节处可见肿胀和畸形。 PhilipPirrip / Wikimedia Commons, CC BY 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会感到手指中间关节疼痛。这通常是由磨损性关节炎或既往损伤引起的。疼痛可能深沉且呈酸痛感。当活动手指时，疼痛也可能表现为锐痛。

疼痛通常在用手后加重。提购物袋、开罐子或打字等活动可能导致搏动性疼痛。您可能会注意到早晨刚醒来时关节僵硬。这种僵硬通常在活动手部几分钟后缓解。然而，在长时间活动后，关节可能会再次感到僵硬。

日常任务可能变得困难。您可能难以将衬衫塞进裤腰，或伸手到背后扣内衣。简单的抓握动作，如拿杯子或转动门把手，可能会引起不适。一些患者发现侧卧睡觉会对关节施加压力，使休息变得更加困难。

在某些情况下，关节可能无法完全伸直。这称为屈曲挛缩。您可能会注意到手指保持轻微弯曲。对于部分患者，连续石膏固定术有助于纠正这种情况。

如果您的疼痛严重且妨碍您进行正常活动，手术可能是一个选择。近端指间关节（PIP）置换术是治疗退行性、创伤后或炎症性关节炎的可靠选择。其目的是缓解疼痛并恢复功能。

您应该知道，关节活动度可能会随时间发生变化。研究表明，随着随访时间延长，活动度可能会恶化。尽管如此，许多患者报告疼痛缓解良好且满意度高。大多数人中位恢复工作时间为8周。

您的外科医生将评估您是否适合该手术。长指（中指）的治疗可能是一个相对禁忌证。早期诊断类风湿关节炎等疾病非常重要。转诊给专科医生可以改善预后。

实际发生了什么

您的手部关节设计为能够顺畅活动。一层薄薄的软骨在骨骼之间起到缓冲作用。在骨关节炎中，这层覆盖物会逐渐磨损。骨骼开始相互摩擦。这会导致疼痛和僵硬。

您手部的肌肉和肌腱协同工作。它们跨越多个关节以产生运动。当关节炎发生时，这种协作机制遭到破坏。您的手部力量减弱。研究表明，患有手部关节炎的女性的握力比健康女性低30%。您可能会发现持物或执行日常任务变得更加困难。

随着疾病进展，您的手指可能无法完成全范围活动。当您尝试握拳或抓取物品时，您可能会注意到活动弧度变小。肌腱和周围结构发生形态改变。这些改变往往是手指畸形的最主要原因，尤其是在早期阶段。

在拇指基部，关节面临独特的应力。压缩剪切力随时间作用于该部位。这可能导致腕掌关节的磨损性关节炎。稳定该关节的韧带变得效力不足。这种不稳定性导致您在拇指基部感受到的疼痛和功能丧失。

理解这些机械变化有助于解释您的症状。疼痛源于骨与骨之间的摩擦和炎症。僵硬源于肌腱和关节的结构改变。您的外科医生利用这些知识来制定治疗方案。目标是恢复顺畅的活动并缓解疼痛。

我们能采取的措施

在罗克汉普顿 Mater 私人医院，Kieran Hirpara 医生通过根据您的日常需求匹配治疗方案来处理这种情况。我们从侵入性最小的选项开始。您可以尝试改变手部使用方式，以避免引起疼痛的动作。温和的锻炼有助于保持关节活动度并增强周围肌肉。我们经常推荐在活动期间使用夹板来支撑关节。请至少给予这些措施六周的时间，以观察其是否有效。

如果疼痛持续存在，我们会讨论医疗选项。非处方止痛药可以减轻不适。抗炎药物有助于减轻关节内的肿胀。我们可能会提供注射治疗以提供更长时间的缓解。皮质类固醇注射可减少炎症，效果可持续数月。透明质酸注射旨在润滑关节，尽管效果因人而异。富血小板血浆注射使用您自身的血液成分来支持愈合，但针对手指关节的证据仍在不断增加。这些治疗可管理症状，但不能逆转关节炎。

当保守治疗不再带来足够的改善时，我们会考虑手术。这是基于您的疼痛程度和功能做出的共同决定。我们评估关节炎是否影响您工作或享受日常任务的能力。如果您符合手术条件，我们可能会讨论关节置换或关节融合术。这些手术旨在缓解疼痛并恢复稳定性。在继续进行之前，我们会与您审查风险和益处。

预期情况

手指关节置换术后的预后取决于您的具体病情及身体愈合情况。对于许多患有磨损性关节炎的患者而言，该手术可提供可靠且长期的疼痛缓解。您可以预期关节在数年内保持稳定且功能良好。研究表明，术后至少两年内，良好的疼痛缓解效果和整体满意度得以维持。部分患者甚至在数十年后仍报告基本无痛且功能良好。

恢复是一个渐进的过程。大多数患者在中位时间 8 周后重返工作岗位。在此期间，您需要密切遵循外科医生的建议以最大限度地减少并发症。减少术后问题是顺利恢复和降低医疗成本的关键。虽然您可能在初期获得良好的关节活动度，但需注意关节活动度可能会随时间推移而恶化。这是某些植入物类型（尤其是用于近端指间关节的植入物）已知的趋势。

若未接受治疗，该关节的关节炎通常会导致持续性疼痛和僵硬。治疗方案各不相同。在某些情况下，非手术方法（如系列石膏固定）可帮助纠正部分患者的僵硬。对于其他患者，关节置换术仍是治疗症状性关节炎的良好且可靠的选择。需要注意的是，治疗长指可能是该手术的相对禁忌证，意味着它并非适合所有人。糖尿病或外科医生的经验等因素也可能影响您的并发症风险。

您的外科医生将根据您的独特临床情况讨论您是否适合接受该手术。目标是提供疼痛缓解并维持功能。虽然总体结果通常积极，但个体结果存在差异。您应对植入物的使用寿命及关节活动度未来可能发生的变化抱有现实的期望。定期随访可确保您的外科医生能够监测您的进展并及早解决任何疑虑。

何时就诊

如果您的中指关节持续性疼痛且休息后无改善，请寻求专科医生评估。若出现无力、关节不稳、关节交锁或打软腿，请及时就医。若症状影响睡眠或工作，或出现突然加重，请联系您的医生。近侧指间关节（PIP）关节置换术适用于骨关节炎或创伤后关节炎。在适当的临床情况下，它是治疗症状性退行性、创伤后或炎症性关节炎的可靠选择。若关节炎导致致残性功能疼痛，我们建议例外情况下采用此治疗方案。早期诊断和适当管理有助于保护您的手部功能。

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Primary proximal interphalangeal joint (PIPJ) utilization for osteoarthritis has increased, while revision PIPJ utilization has decreased [1].
  • Surgery performed better than collagenase at early and 2-year follow-up in PIP joints [2].
  • PIPJ arthrodesis has very few contraindications and an excellent overall success rate, making it an excellent option for surgical management of PIPJ arthritis [3].
  • Reoperations following primary nonconstrained PIP joint arthroplasties are common [5].
  • Extensor mechanism dysfunction is the most frequent cause of reoperation following primary nonconstrained PIP joint arthroplasty [5].
  • Clinical outcomes for PIP joint replacements with pyrocarbon implants are variable despite substantially good survivorship [7].
  • The survival of pyrocarbon PIP joint arthroplasty was 85% at 5 years of follow-up [10].
  • Pyrocarbon PIP joint arthroplasty is associated with high patient satisfaction [10].
  • PIP joint denervation provides durable, effective pain relief with high patient satisfaction despite osteoarthritis progression [11].
  • PIP joint denervation supports its consideration as a surgical option for symptomatic PIP joint osteoarthritis [11].
  • Ultimate salvage for a failed PIP joint arthroplasty may require arthrodesis or even amputation [12].
  • Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty [16].
  • Reoperations following primary non-constrained PIP arthroplasties are common [18].
  • Pyrocarbon PIPJ replacement is a safe and effective treatment for arthritis of the PIPJ [20].
  • Pyrocarbon PIPJ replacement provides excellent pain relief [20].
  • Pyrocarbon PIPJ replacement increases the arc of motion by more than double the preoperative range [20].

Anatomy & Pathophysiology

  • Maintaining concentric reduction of the PIP joint is a main goal in treating PIP joint complications [4].
  • Restoring joint stability is a main goal in treating PIP joint complications [4].
  • Facilitating early range-of-motion exercises is a main goal in treating PIP joint complications [4] [6].
  • Maintaining motion and function following trauma and/or surgery of the PIP joint remains very challenging [6].
  • Proper biomechanics of a joint must be restored to achieve full, functional range of motion [28].
  • The anatomy of the PIPJ remains a subject of ongoing investigation [29].
  • Evolving understanding of the biomechanical properties of the PIPJ will continue to improve treatment and reconstructive designs [29].
  • Hand therapy programs for the PIP joint must address the specific disorder, timing of injury, and phases of healing to prevent stiffness and dysfunction [30].
  • Stiffness of the PIP joint is a challenging problem that may be successfully treated under the guidance of a hand therapist [31].
  • Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand [33].
  • It is more difficult to maintain posture for the ring and little fingers due to deforming forces [35].
  • Implant fractures did not significantly affect upper limb function [39].
  • Establishment of normative values for soft-tissue redundancy may enable surgeons to explain the lack of progress after surgical joint release [40].
  • Establishment of normative values for soft-tissue redundancy may enable surgeons to determine progress with hand therapy [40].
  • Establishment of normative values for soft-tissue redundancy may enable surgeons to choose the optimal timing of surgical intervention once soft-tissue equilibrium is achieved [40].
  • Simulated arthrodesis of the middle finger affected grip strength more than that of the ring finger [41].
  • Patients with greater hand function preoperatively may be at higher risk of revision surgery after silicone metacarpophalangeal joint arthroplasty [42].
  • The hypothesis that ulnar fingers would have worse outcomes than radial fingers was not proven [44].
  • Sufficient correction of deformities in ulnar fingers is possible if adequate bone resection and realigning of the extensor mechanism are carefully performed [44].
  • The authors recommend using a surface replacing implant in fingers with preoperative axis deviations and correctable anatomical situation [46].
  • There is a higher risk of a second surgery when using a surface replacing implant in fingers with preoperative axis deviations and correctable anatomical situation [46].
  • Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes in toe-to-finger vascularized joint transfers [47].
  • An IP joint fusion of the thumb or DIP joint fusion of the fingers can be performed safely with a low-profile plate fixation through a dorsal approach [50].
  • The extensor mechanism and central slip insertion to the middle phalanx must be reconstructed meticulously to improve joint motion and decrease extension lag in vascularized toe joint transfers [51].
  • Design of a lateral skin flap paddle allows better coverage of vessels and extensor repairs in vascularized toe joint transfers [51].
  • Selective arthrodesis is helpful in restoring hand function when normal painless joint function cannot be restored [52].
  • No border digit PIP joint arthrodesis angle was superior for grip and pinch strength [53].
  • Surgical intervention markedly improves hand and wrist function for many rheumatoid patients [54].

Classification

  • The SCARF classification system allows specification of every PIP joint dislocation type, even for non-hand specialists [32].
  • Treatment of PIP joint fracture dislocations is based on joint stability, fracture fragment size, and soft tissue injuries [55].

Clinical Presentation

  • Primary PIP joint arthroplasty utilization for osteoarthritis has increased, while revision PIP joint arthroplasty utilization has decreased [1].
  • Surgery performed better than collagenase enzymatic fasciotomy at early and 2-year follow-up in PIP joints affected by Dupuytren disease [2].
  • PIP joint arthrodesis has an excellent overall success rate and very few contraindications, making it an excellent option for surgical management of PIP joint arthritis [3].
  • The main goals of treatment for PIP joint complications are maintaining concentric reduction of the joint, restoring joint stability, and facilitating early range-of-motion exercises [4].
  • Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [5].
  • Clinical outcomes for PIP joint replacements with pyrolytic carbon implants are variable despite substantially good survivorship [7].
  • PIP joint range of motion deteriorates over time in patients undergoing pyrolytic carbon hemiarthroplasty for PIP joint arthritis [8].
  • 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 [11].
  • PIP joint implant arthroplasty is a good and reliable option for symptomatic PIP joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [13].
  • Patients returned to work after a median of 8 weeks following PIP arthroplasty [14].
  • Periprosthetic joint infection is uncommon after MCP or PIP arthroplasties [15].
  • It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains [17].
  • Early recognition of joint instability is essential for adequate treatment of injuries of the PIP joint [21].
  • Timely diagnosis of PIP joint fracture dislocations is imperative, as they may rapidly develop fixed deformity if there is persistent incongruity of the joint [22].
  • 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 [36].
  • PIP joint stiffness remains an unsolved problem in hand surgery, with poor prognosis in complex cases even after complete arthrolysis and tenolysis [37].

Investigations

  • Primary proximal interphalangeal joint arthroplasty (PIPA) utilization for osteoarthritis has increased, while revision PIPA has decreased [1].
  • Surgery performed better than collagenase at early and 2-year follow-up in PIP joints affected by Dupuytren Tubiana stage 1–3 [2].
  • Patients should be advised that PIPJ range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [8].
  • PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting [13].
  • Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [15].
  • Timely diagnosis is imperative for PIP joint fracture dislocations, especially if there is any persistent incongruity of the joint, as they may rapidly develop fixed deformity [22].
  • Open reduction of chronic untreated PIP joint dislocations can successfully achieve a functional range of motion with a stable joint [25].
  • 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 [26].
  • Pyrocarbon prosthesis replacement of the PIP joint 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 [27].
  • Vascularized toe joint transfer reconstruction of the dysfunctional finger PIPJ is a valuable tool that should be considered in well-selected patients [56].

Treatment

  • Primary proximal interphalangeal joint implant (PIPA) utilization for osteoarthritis has increased, while revision PIPA has decreased [1].
  • Patients should be advised that PIPJ range of motion deteriorates over time [8].
  • 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 [20].
  • External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results [23].
  • The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint [24].
  • 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 [43].
  • The reoperation rate after pyrocarbon PIP arthroplasty was 30% [49].

Complications

  • Revision proximal interphalangeal joint arthroplasty (PIPA) utilization has decreased [1].
  • Clinical outcomes for PIP joint replacements with pyrolytic carbon implants are variable [7].
  • Range of motion in PIP joints deteriorates over time following arthroplasty with pyrolytic carbon implants [8].
  • Salvage of a failed PIP joint arthroplasty may require arthrodesis or amputation [12].
  • Periprosthetic joint infection (PJI) is uncommon after primary metacarpophalangeal (MCP) or PIP arthroplasties [15].
  • Intraoperative periprosthetic fractures occur in approximately 5% of PIP joint arthroplasties [34].
  • Intraoperative periprosthetic fractures do not influence outcomes, including revision surgery, refracture rate, or other early complications [34].
  • The LPM PIP joint prosthesis had an unacceptable revision rate of 29% and a further 20% rate of adverse clinical and radiological outcomes at a maximum follow-up of 6 years [38].
  • Component loosening typical of earlier PIP and MCP joint surface replacement implant designs has not been a problem in initial reports [19].
  • Prolonged swelling, stiffness, and dysfunction are common following PIP joint sprains [17].

Recovery

  • Extensor mechanism dysfunction is the most frequent cause of reoperation following primary nonconstrained PIP joint arthroplasties [5].
  • Patients should be advised that PIP joint range of motion deteriorates over time [8].
  • High patient satisfaction is associated with pyrocarbon PIP joint arthroplasty [10].
  • Type of work and preoperative ability to perform work affect return to usual work following PIP joint arthroplasty for osteoarthritis [14].
  • 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 [19].
  • Pyrocarbon prosthesis replacing the PIP joint provides good pain relief and stable radiographic integration at 5 years [27].
  • No late revisions or loosening were observed with pyrocarbon prosthesis replacing the PIP joint at 5 years [27].
  • Pyrocarbon prosthesis replacing the PIP joint showed no improvement in range of motion at 5 years [27].
  • Using night progressive static and daily dynamic orthoses as an exclusive treatment during the proliferative phase led to significant improvements in PIP joint active extension [57].
  • The improvement in PIP joint active extension from orthotic treatment did not correlate with increased function as perceived by the patient [57].
  • Early results of pyrolytic carbon surface replacement arthroplasty for posttraumatic, degenerative, and inflammatory arthritic disease of the PIP joint are encouraging [58].
  • Early results of pyrolytic carbon surface replacement arthroplasty for PIP joint disease compare favorably with prior reports of implants made of different materials [58].

Key Evidence

  • [L4] The data demonstrate an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased. [1] (10.1177/1558944719837009)
  • [L3] Surgery performed better than collagenase at early and 2-year follow-up in PIP joints and similarly in MCP joints. [2] (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. [3] (10.1016/j.hcl.2017.12.007)
  • [L5] The main goals of any treatment of a PIP joint complication are maintaining concentric reduction of the joint, restoring joint stability, and facilitating early range-of-motion exercises. [4] (10.1016/j.hcl.2017.12.014)
  • [L4] Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause. [5] (10.1016/j.jhsa.2011.06.002)
  • [L5] Maintaining motion and function following trauma and/or surgery of the PIP joint remains very challenging. [6] (10.1016/j.hcl.2017.12.003)
  • [L4] Despite substantially good survivorship, clinical outcomes for PIP joint replacements with pyrocarbon implants are variable. [7] (10.1302/2058-5241.2.160041)
  • [L4] Patients should be advised that PIPJ ROM deteriorates over time. [8] (10.1016/j.jhsa.2023.11.007)
  • [L4] The survival of pyrocarbon PIP joint arthroplasty was 85% at 5 years of follow-up, with high patient satisfaction. [10] (10.1016/j.jhsa.2012.02.012)
  • [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. [11] (10.1016/j.jhsa.2026.01.033)
  • [L5] Ultimate salvage for the failed PIP joint arthroplasty may require arthrodesis or even amputation. [12] (10.1016/j.hcl.2017.12.011)
  • [L4] PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. [13] (10.1177/17531934241265837)
  • [L3] Patients returned to work after a median of 8 weeks following PIP arthroplasty. [14] (10.1177/15589447221141485)
  • [L4] PJI is uncommon after MCP or PIP arthroplasties. [15] (10.1016/j.jhsa.2024.12.008)
  • [L1] Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. [16] (10.1177/1558944718791186)
  • [L4] It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. [17] (10.1016/j.jhsa.2023.01.025)
  • [L4] Reoperations following primary non-constrained PIP arthroplasties are common. [18] (10.1016/s0363-5023(11)60049-x)
  • [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. [19] (10.5435/00124635-200309000-00002)
  • [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. [20] (10.1177/1753193411434053)
  • [L5] Early recognition of joint instability is essential for adequate treatment of injuries of the PIP joint. [21] (10.5435/00124635-200011000-00006)
  • [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. [22] (10.1016/j.hcl.2012.05.036)
  • [L4] External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results. [23] (10.1016/j.jhsa.2013.07.007)
  • [L4] The CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint. [24] (10.1177/1753193420977244)
  • [L4] This surgical technique of open reduction of chronic untreated PIP joint dislocations can successfully achieve a functional range of motion with a stable joint. [25] (10.1016/j.jhsa.2020.07.002)
  • [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. [26] (10.1055/a-0833-8729)
  • [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. [27] (10.1177/1753193413479527)
  • [L5] Proper biomechanics of a joint must be restored to achieve full, functional range of motion. [28] (10.1016/j.hcl.2017.12.008)
  • [L5] Despite the wealth of knowledge regarding the anatomy of the PIPJ, it remains a subject of ongoing investigation, and evolving understanding of its biomechanical properties will continue to improve treatment and reconstructive designs. [29] (10.1016/j.hcl.2017.12.002)
  • [Paper] Hand therapy programs for the proximal interphalangeal joint must address the specific disorder, timing of injury, and phases of healing to prevent stiffness and dysfunction. [30] (10.1016/j.hcl.2018.01.001)
  • [L5] Stiffness of the PIP joint is a challenging problem that may be successfully treated under the guidance of a hand therapist. [31] (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. [32] (10.1016/j.jos.2019.08.007)
  • [L5] Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. [33] (10.1177/1753193414559464)
  • [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. [34] (10.1016/j.jhsa.2015.06.101)
  • [L2] Although past experiences have indicated that it is more difficult to maintain posture for the ring and little fingers due to the deforming forces, it is certainly possible if attention to adequate bone resection and realigning of the extensor mechanism is carefully taken during the surgical procedure. [35] (10.1016/s0363-5023(09)60133-7)
  • [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. [36] (10.1177/17531934231183259)
  • [L5] PIP joint stiffness remains an unsolved problem in hand surgery, with poor prognosis in complex cases even after complete arthrolysis and tenolysis. [37] (10.1177/17531934221143690)
  • [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. [38] (10.1177/1753193408094920)
  • [L4] However, implant fractures did not significantly affect upper limb function. [39] (10.1016/j.jhsa.2024.01.009)
  • [L3] Establishment of normative values may enable surgeons to explain the lack of progress after surgical joint release, determine progress with hand therapy, and choose the optimal timing of surgical intervention once soft-tissue equilibrium is achieved. [40] (10.1016/j.jhsg.2025.100748)
  • [L4] Simulated arthrodesis of the middle finger affected the grip strength more than that of the ring finger. [41] (10.1007/s00402-021-04317-w)
  • [L3] Patients with greater hand function preoperatively may be at higher risk of revision surgery. [42] (10.1177/1558944719831236)
  • [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. [43] (10.1177/1753193414566552)
  • [L2] The hypothesis that ulnar fingers would have worse outcomes than radial fingers was not proven; sufficient correction of deformities in ulnar fingers is possible if adequate bone resection and realigning of the extensor mechanism are carefully performed. [44] (10.1016/j.jhsa.2009.06.029)
  • [L4] The authors recommend using a surface replacing implant in fingers with preoperative axis deviations and correctable anatomical situation, bearing in mind the higher risk of a second surgery. [46] (10.1007/s00402-020-03663-5)
  • [L4] Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes. [47] (10.1177/1558944720988081)
  • [Paper] The reoperation rate after pyrocarbon PIP arthroplasty was 30%. [49] (10.1055/s-0040-1709088)
  • [L4] An IP joint fusion of the thumb or DIP joint fusion of the fingers can be performed safely with a low-profile plate fixation through a dorsal approach. [50] (10.1016/j.jhsa.2018.03.049)
  • [L4] The extensor mechanism and central slip insertion to the middle phalanx must be reconstructed meticulously to improve joint motion and decrease extension lag, and design of a lateral skin flap paddle to better cover vessels and allow extensor repairs. [51] (10.1177/1753193419857475)
  • [L4] Selective arthrodesis is helpful in restoring hand function when normal painless joint function cannot be restored. [52] (10.1016/s0039-6109(16)36053-4)
  • [L4] No border digit PIP joint arthrodesis angle was superior for grip and pinch strength. [53] (10.1016/j.jhsa.2019.11.008)
  • [L5] Surgical intervention markedly improves hand and wrist function for many rheumatoid patients. [54] (10.5435/jaaos-d-20-00102)
  • [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. [55] (10.1016/j.hcl.2017.12.005)
  • [L4] Vascularized toe joint transfer reconstruction of the dysfunctional finger PIPJ is a valuable tool that should be considered in well-selected patients. [56] (10.1016/j.hcl.2017.12.010)
  • [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. [57] (10.1016/j.jhsa.2015.01.005)
  • [L5] Early results of pyrolytic carbon surface replacement arthroplasty for posttraumatic, degenerative, and inflammatory arthritic disease of the PIP joint are encouraging and compare favorably with prior reports of implants made of different materials. [58] (10.5435/00124635-200703000-00009)

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

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

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

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[32] 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

[33] Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414559464

[34] Intraoperative Periprosthetic Fractures in Proximal Interphalangeal Joint Arthroplasty. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.101

[35] Outcomes of Silicone Arthroplasty Stratified by Fingers for the Rheumatoid Metacarpophalangeal Joints. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60133-7

[36] Proximal interphalangeal joint dislocations and fracture-dislocations. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231183259

[37] The stiff proximal interphalangeal joint – an unsolved problem?. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221143690

[38] A Report on the Early Failure of the LPM Proximal Interphalangeal Joint Replacement. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408094920

[39] 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

[40] A Novel Technique to Assess Soft-Tissue Redundancy Over the Proximal Interphalangeal Joint. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100748

[41] The impact of various simulated arthrodesis angles of the proximal interphalangeal joint of the ring and middle finger on grip strength. Archives of Orthopaedic and Trauma Surgery. 2022. DOI: 10.1007/s00402-021-04317-w

[42] Factors Associated With Reoperation After Silicone Metacarpophalangeal Joint Arthroplasty in Patients With Inflammatory Arthritis. HAND. 2019. DOI: 10.1177/1558944719831236

[43] 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

[44] Outcomes of Silicone Arthroplasty for Rheumatoid Metacarpophalangeal Joints Stratified by Fingers. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.06.029

[46] Complications after surface replacing and silicone PIP arthroplasty: an analysis of 703 implants. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03663-5

[47] Toe-to-Finger Vascularized Joint Transfers for Proximal Interphalangeal Joint Reconstruction: A Systematic Review. HAND. 2021. DOI: 10.1177/1558944720988081

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