Proximal interphalangeal joint arthroplasty: implants and surgical approaches

Proximal interphalangeal (PIP) joint arthroplasty remains an established surgical treatment option for the arthritic and painful PIP joint. A variety of materials have been used for arthroplasty including silicone, metal-plastic, and pyrolytic carbon. In addition, constrained and semiconstrained designs have been used. The constrained implants are more commonly indicated for patients with incompetent ligaments or poor soft-tissue stabilizers. A variety of surgical approaches have been proposed, including volar, dorsal, and lateral techniques. The volar approach is more commonly used with the silicone implants, as the more precise cuts for newer nonconstrained implants were designed with the instrumentation in mind for the dorsal approach. Outcomes of PIP joint arthroplasty generally reflect excellent pain relief. Arthroplasty does afford some mobility, as opposed to arthrodesis, of the PIP joint. However, range of motion after PIP joint replacement is less predictable and may not provide improvement compared with preoperative measures. Unfortunately, reoperation rates after PIP joint arthroplasty are not inconsequential, and salvage of failed arthroplasty options are limited and include (not uncommonly) arthrodesis. Thus, counseling of the patient regarding risk and benefits of the arthroplasty is critical in tempering expectations and helping the patient determine their best treatment.