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Education · hand

PIP Joint Arthritis Info In-depth Evidence

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

What you're feeling

You may notice a deep ache in the middle joint of your finger. This is the proximal interphalangeal joint, or PIP joint. The pain often comes from wear-and-tear arthritis or damage from an old injury. You might feel stiffness when you first wake up in the morning. This stiffness usually eases as you move your hand throughout the day.

The pain tends to flare after you use your hand for tasks. Simple daily activities can become difficult. You might struggle to grip a cup firmly without it slipping. Buttoning a shirt or turning a key in a lock may feel painful or awkward. If you have inflammatory arthritis, the joint may feel warm or swollen. This discomfort can interfere with your ability to perform routine tasks that require fine motor skills.

Your surgeon will assess whether this pain is invalidating your daily function. If conservative treatments do not help, joint replacement may be an option. This procedure aims to relieve pain and restore movement. However, you should be aware that range of motion in the joint can deteriorate over time. Serial casting may be recommended to help correct stiffness if you develop a flexion contracture.

We understand that living with hand pain is frustrating. Our goal is to help you regain comfort and function. We will discuss the best approach for your specific situation. This may include surgery or other management strategies. We aim to minimize complications and support your recovery. You can expect to return to work after a median of 8 weeks following surgery. We will guide you through each step of this process.

What's actually happening

Your finger joints are designed to work as a team. When one part changes, the others must adjust. This is called interdependency. In hand arthritis, the smooth surfaces that let your bones glide become rough and worn. This wear-and-tear reduces your grip strength by about 30%. You may find your fingers move through a smaller range of motion during daily tasks.

The tendons that pull your fingers are like ropes of fibres. They cross multiple joints to create movement. When arthritis develops, these tendons and their supporting structures change early on. This is the main cause of finger deformities. The tendons no longer pull evenly. This imbalance leads to the crooked or stiff appearance often seen in advanced arthritis.

At the base of your thumb, the joint faces high compressive and shear forces. Over time, these forces wear down the cartilage. This is known as basal joint arthritis. It is a progressive condition. The ligaments that stabilise this joint may stretch or weaken. This allows the bone to shift out of place. The result is pain and instability when you pinch or grip objects.

For joints higher up in your fingers, such as the middle knuckle, the internal structure of the bone affects how stress is distributed. Arthritis here can limit your ability to bend or straighten the finger fully. While some treatments aim to replace the damaged joint surface, the underlying issue remains the breakdown of these delicate structures. Understanding this mechanical failure helps explain why simple rest often isn't enough. The joint needs support to restore function and reduce pain.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. We begin by helping you manage symptoms through simple changes to your daily activities and targeted hand therapy. Your therapist will guide you through exercises to maintain movement and strengthen the surrounding muscles. In some cases, we may use serial casting to gently correct stiffness if your finger tends to stay bent. We usually recommend giving this non-operative care a fair trial before considering more advanced steps.

If symptoms persist, we discuss medical management to help you stay comfortable. This may include pain relief medication and anti-inflammatory drugs to reduce swelling and ache. We can also offer injections into the joint. Cortisone injections are commonly used to calm inflammation and provide temporary relief. Hyaluronic acid or platelet-rich plasma (PRP) injections are other options that aim to support the joint environment. These treatments do not cure the arthritis, but they can help you function better for a period of time while you continue with your therapy.

Surgery is considered when conservative care has not given enough improvement or when pain is severely limiting your life. We offer joint replacement (arthroplasty) to remove damaged joint surfaces and replace them with an implant. This can provide reliable, long-term pain relief and help maintain function. Patients typically return to work after a median of 8 weeks following this procedure. Some implants offer good pain relief and satisfaction, while others may see a gradual change in movement over time. We also use techniques like fusing the joint (arthrodesis) in specific cases to provide stability. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment (history, examination, and imaging where needed) establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care — activity change, physiotherapy or hand therapy, splinting, and injections — and consider surgery when that has not given enough improvement. For structural or acute problems, surgery may be recommended straight away, without a preceding non-operative trial.

What to expect

You can expect reliable, long-term pain relief and maintained hand function from this procedure. Most patients report good overall satisfaction with their results. The implant integrates well with your bone, and studies show stable integration at five years with no late loosening. You will likely find your hand remains essentially pain-free and well-functioning for many years.

Your recovery timeline varies, but most people return to work after a median of 8 weeks. This means half of patients go back sooner, and half take longer. You should plan for a gradual return to daily activities rather than an immediate restart. While you may achieve good range of motion initially, it is important to know that joint movement tends to deteriorate over time. This is a natural part of the process for many patients, so your surgeon will discuss how to manage this expectation.

If left untreated, arthritis in this joint often leads to persistent stiffness and pain. Treatment with an anatomically neutral implant provides a reliable option for symptomatic degenerative, post-traumatic, or inflammatory arthritis. For some patients, silicone implants or surface replacement arthroplasty are also good options for pain relief. In selected cases, serial casting can help correct flexion contractures. However, treatment of the long finger may be a relative contraindication to this surgery, so your surgeon will assess if you are a suitable candidate.

Diabetes and surgeon experience are factors that can influence the risk of postoperative complications. Minimizing these risks is key to a smooth recovery and lower healthcare costs. While some patients may experience a decline in range of motion over the long term, the primary goal of pain relief and functional maintenance is typically achieved. You should feel confident that this is a good and reliable option when performed in the proper clinical setting.

When to see someone

Ask for a specialist review if you have persistent pain in your finger joint that does not improve with rest. Seek care if you notice weakness, instability, or if the joint locks or gives way. See your GP if symptoms interfere with your sleep or work. Sudden worsening of pain is also a reason to seek help. PIP joint arthroplasty is indicated for osteoarthritis or posttraumatic arthritis. It may be proposed if arthritis causes invalidating functional pain. However, treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. Early diagnosis is important for conditions like rheumatoid arthritis.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Arthritis of the middle finger joint is worth the extra reading because the choice between fusing it and replacing it is decided by something most people would not think to ask about — whether the joint is stable — and because which finger it is matters as much as what the X-ray shows.

Stability, not severity, chooses the operation

Two operations are available. Fusion sets the joint permanently in a chosen position, reliably removing pain at the cost of all movement. Replacement preserves movement.

The comparison across 1,868 patients defines when each is appropriate. Silicone implants remain a valuable option for stable joints, while surface-replacing implants might be better for unstable or deviated joints — although they carry a higher risk of reoperation [1].

The important variable there is stability. A silicone implant is a flexible spacer rather than a hinge; it works by sitting between the bone ends and allowing them to move around it, which requires the surrounding ligaments to provide the stability. Where those ligaments have failed and the joint deviates sideways, a spacer has nothing to work against — hence the move to a surface-replacing design, and hence the higher reoperation rate that comes with a more constrained implant.

Which finger it is changes the recommendation

This is the part rarely explained. The index finger takes a large sideways force in pinch — pressing against the thumb — and that force is exactly what a replaced joint tolerates least. The ring and little fingers are used mainly for grip, where the loads run along the finger rather than across it.

The practical consequence is that replacement is generally better suited to the ulnar fingers, and fusion is often preferred at the index, where a stable post to pinch against is worth more than movement. Two identical-looking joints on an X-ray can therefore attract different recommendations based only on their position in the hand.

Fusion is reliable, and the technique matters less than expected

Where fusion is chosen, the technique debate is modest. Across 1,923 patients, all described techniques can achieve the goal of fusing an osteoarthritic joint, with a trend in more recent literature towards compression techniques [2]. Comparing techniques directly across 286 patients, they had similar fusion time, nonunion and complication rates — with screw arthrodesis showing a lower nonunion rate than wire fusion, though the data carry significant limitations [3].

Where the joint has been destroyed by injury rather than wear

A fracture through the base of the middle bone destroys the joint surface directly. Where more than half the surface is involved, one option is to rebuild it with a graft taken from the hamate bone in the wrist, whose contour resembles the lost joint surface.

Hemi-hamate autograft can be considered reliable for acute and chronic fracture-dislocations with joint involvement greater than 50%, though longer-term follow-up is required — particularly to establish the rate of later arthritis [4]. A separate review of 235 patients found it affords symptomatic relief and functional restoration [5].

That outstanding question about later arthritis is the honest caveat: the graft restores the shape of the joint, and whether a reconstructed surface wears at the same rate as a native one is not yet answered.

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.

References for the advanced reading
  1. Forster N, Schindele S, Audigé L, Marks M. Complications, reoperations and revisions after proximal interphalangeal joint arthroplasty: a systematic review. J Hand Surg Eur Vol. 2018;43(10):1066-75.
  2. Millrose M, Gesslein M, Ittermann T, Kim S, Vonderlind H, Ruettermann M. Arthrodesis of the proximal interphalangeal joint of the finger – a systematic review. EFORT Open Rev. 2022;7(1):49-58.
  3. Faulkner H, An V, Lawson RD, Graham DJ, Sivakumar BS. Proximal interphalangeal joint arthrodesis techniques: a systematic review. Hand (N Y). 2021;18(1):74-9.
  4. Frueh FS, Calcagni M, Lindenblatt N. The hemi-hamate autograft arthroplasty in proximal interphalangeal joint reconstruction: a systematic review. J Hand Surg Eur Vol. 2014;40(1):24-32.
  5. Faulkner H, Graham DJ, Hile M, Lawson RD, Sivakumar BS. Hemi-hamate arthroplasty for base of middle phalanx fracture: a systematic review. Hand (N Y). 2021;18(2):300-6.
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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