PIP Arthroplasty:

Arthroplasty, or joint replacement, of the proximal interphalangeal joint of the digits is a treatment option to relieve the stiffness, pain, decreased strength, and angular deformity that are seen in patients with rheumatoid, degenerative, or post-traumatic arthritis. The early non-operative management of degenerative interphalangeal osteoarthritis includes rest and splinting during periods of inflammation, non-steroidal inflammatory medications, and occasionally intra-articular injection of a corticosteroid medication. Rheumatoid arthritis of the interphalangeal joints is treated with antirheumatic drugs. Operative intervention is considered when the patient has pain that is not relieved with medical management, or when joint stiffness and deformity interfere with daily activities and overall hand function. Arthroplasty (joint replacement), involves removal of the diseased joint and replacement with one of a variety of prosthetic implants that will allow a limited, pain-free range of motion at the joint. Good candidates for arthroplasty have low demand work and leisure activities with respect to use of their hands. Patients with high-demand requirements may be better managed with joint fusion (arthrodesis) which offers reliable pain relief and stability, but no motion at the joint.

The evaluation of patients with interphalangeal arthritis that are potential candidates for arthroplasty includes a comprehensive history and physical examination, as well as a series of radiographs to evaluate the extent of disease. Particular attention is given to the patient's expectations for the type of activities that he or she will be able to do with the hand after surgery. A silicone or pyrocarbon joint replacement implant is selected based in part on the patient's underlying disease process, and the stability of the ligamentous tissues surrounding the joint. Arthroplasty is generally preformed in an ambulatory setting under a regional or general an incision on the back or side of the digit. Patients are immobilized in a splint for the first 3 weeks after surgery, and then a program of gentle movement is started under the guidance of an occupational therapist within our facility. While arthroplasty can provide excellent pain relief and improved range of motion, implant failure (breakage or dislocation) may occur over time with use and may require revision surgery. The hand surgeons at the University of Washington Hand Center can evaluate patients that have a need for revision of interphalangeal joint implant arthroplasty to determine the best course of management.

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