Artrite da Articulação Interfalangeana Proximal Folheto

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)

References

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

[2] Range of motion, postoperative rehabilitation and patient satisfaction in MCP and PIP joints affected by Dupuytren Tubiana stage 1–3: collagenase enzymatic fasciotomy or limited fasciectomy? A clinical study in 52 patients. Archives of Orthopaedic and Trauma Surgery. 2018. DOI: 10.1007/s00402-018-3034-6

[3] Proximal Interphalangeal Joint Fusion. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.007

[4] Complications of Proximal Interphalangeal Joint Injuries. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.014

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

[6] Surgical Exposure of the Proximal Interphalangeal Joint. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.003

[7] Proximal interphalangeal (PIP) joint replacements with pyrolytic carbon implants in the hand. EFORT Open Reviews. 2017. DOI: 10.1302/2058-5241.2.160041

[8] Pyrolytic Carbon Hemiarthroplasty for Proximal Interphalangeal Joint Arthritis, Long-Term Follow-Up. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.11.007

[10] Pyrocarbon Proximal Interphalangeal Joint Arthroplasty: Minimum Two-Year Follow-Up. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.012

[11] Long-term Survival of Proximal Interphalangeal Joint Denervation of the Hand: Time-to-Event Analysis. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.033

[12] Salvaging a Failed Proximal Interphalangeal Joint Implant. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.011

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

[14] 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

[15] 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

[16] 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

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

[18] Reoperations following Proximal Interphalangeal Joint Unconstrained Arthroplasty. The Journal of Hand Surgery. 2011. DOI: 10.1016/s0363-5023(11)60049-x

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

[20] Pyrocarbon proximal interphalangeal joint arthroplasty: outcomes of a cohort study. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193411434053

[21] Fractures of the Proximal Interphalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 2000. DOI: 10.5435/00124635-200011000-00006

[22] Proximal Interphalangeal Joint Fracture Dislocations. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.036

[23] Distraction for Proximal Interphalangeal Joint Contractures: Long-Term Results. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.07.007

[24] 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

[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

[27] 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

[28] Advances in Proximal Interphalangeal Joint Arthroplasty. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.008

[29] Anatomy and Biomechanics of the Finger Proximal Interphalangeal Joint. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.002

[30] Therapy Concepts for the Proximal Interphalangeal Joint. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2018.01.001

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

[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

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