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PIP Joint Replacement

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PIP joint replacement addresses painful arthritis in the middle finger joint when non-surgical options fail.

Updated Aug 2026

A hand-drawn illustration of a middle-finger joint replacement implant. — The PIP joint is the middle of the three finger joints. A replacement resurfaces the joint with an implant rather than fusing it solid. Kieran Hirpara 4.0

Why this operation has been suggested¶

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. 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 establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care — activity change, hand therapy, splinting, and injections — and consider surgery when that has not given enough improvement.

We suggest this joint replacement to relieve pain and restore motion when wear-and-tear arthritis limits your hand function. The procedure replaces the damaged joint surfaces to maintain stability. Approximately 1 in 5 procedures with a pyrocarbon implant require revision surgery by 5 years. About 1 in 3 patients undergo more than one operation. We discuss these figures with you to support a shared decision. The main benefit is reliable pain relief and improved hand function.

Before the operation¶

We want you to feel ready and safe. Please arrange a lift home for after your surgery. Wear comfortable clothing that is easy to take off. Bring a full list of your current medications. Your surgeon will tell you exactly which medicines to stop and when. You may need blood tests, an anaesthetic review, or scans like X-rays or MRI. These checks help us plan your care safely. We use a volar approach, meaning the incision is on the palm side of your finger joint. This is a standard open procedure through a single cut. We will guide you through every step so you know what to expect.

On the day¶

You present to the hospital’s surgical admissions unit. You are checked in and prepared for theatre. You meet the anaesthetist to discuss your care. This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief — the anaesthetist decides on the day based on your individual circumstances.

You are then taken into the operating theatre, where the operation is performed. Dr Hirpara uses a volar (palm-side) approach for this procedure. You wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery. We ensure you are comfortable and ready for the next step in your journey.

What the operation involves¶

We perform this procedure through a single cut on the palm side of your finger joint. This approach gives your surgeon clear access to the area that needs treatment. You do not need to worry about multiple scars or complex entry points; just one incision is used.

Inside, your surgeon removes the worn-out surfaces of the joint. These are the parts of the bone that have become rough and painful due to arthritis. The surgeon then replaces these surfaces with a new implant. This device is designed to mimic the natural movement of your finger. It helps to maintain motion in the joint, which is often lost in severe arthritis. The goal is to keep your finger mobile and reduce pain, rather than fusing the bones together.

Once the new joint surfaces are in place, the cut is closed. Your surgeon uses stitches to bring the skin edges together. A dressing is applied to protect the area as it begins to heal. The entire process is focused on restoring function to your specific finger joint.

This method is chosen to provide stability and motion. It avoids the need for arthrodesis, which is the surgical fusion of the joint. By keeping the joint mobile, you retain more natural hand function. The procedure is tailored to your individual anatomy and the condition of your joint.

After the operation¶

You will wake up in the recovery ward with your hand dressed and elevated. Dr Hirpara uses a palm-side incision for this surgery. Most patients stay one night in hospital after this operation, though some are able to go home the same day. You must have someone stay with you for the first 24 hours. We provide clear pain management and wound care instructions to keep you comfortable. Your hand will be protected by a soft dressing. You must not drive while wearing a finger splint, as it prevents a safe grip on the wheel. Please read our guide on Driving after upper-limb surgery for more details.

Recovery¶

You will notice swelling and stiffness in your finger after surgery. This is normal. We manage this with elevation and gentle movement. Your surgeon uses a volar (palm-side) approach for your procedure. This allows for early motion to help you recover faster.

You will wear a protective splint for several weeks. Do not drive while wearing this splint if it limits your grip on the steering wheel. You can drive once the splint is removed and your surgeon clears you. See Driving after upper-limb surgery for more details.

We guide your rehabilitation with Ruby Doolan at Extend Rehabilitation. She helps you regain motion while protecting your healing tissues. You will do simple exercises to reduce stiffness. These movements feel challenging at first but become easier as you heal.

Your timeline may differ from others. Your surgeon and hand therapist will guide your progress based on how your finger responds. Focus on steady improvement rather than speed. Most patients find daily tasks become easier as swelling settles and strength returns.

What can go wrong¶

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

If you have surgery on more than one finger, the experience is generally similar to having it done on just one finger. You should not expect worse results or higher risks simply because multiple joints are being treated. The healing process and potential complications remain comparable whether one or several fingers are involved.

Sometimes, the joint may not heal as expected, requiring another operation to fix it. This is known as a secondary surgical procedure. You might notice that your finger remains stiff, painful, or unstable after your initial recovery period. If your hand feels different than it should or function does not improve as hoped, let your surgeon know. They can assess whether further treatment is needed to help the joint work better.

In some cases, the implant may wear out or fail over time, particularly if a previous replacement was being revised. Revision surgery means replacing an old implant with a new one. This type of procedure carries a higher risk of complications compared to the first surgery. You might experience increased pain, swelling, or a change in how the finger moves. If you notice these changes years after your initial operation, contact the clinic for an evaluation.

The complications table on this page lists typical rates if you want the specifics.

When to call us¶

Call us if you have fever, increasing wound redness or discharge, sudden severe pain, calf swelling, shortness of breath, loss of sensation, or inability to move your finger. These signs need urgent assessment. We are here to help you stay safe during your recovery.

Where to read more¶

This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the PIP Joint Arthritis page.

Where to read more about the condition¶

This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the PIP Joint Arthritis page.

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