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PIP Joint Arthritis

Osteoarthritis and inflammatory arthritis of the PIP joint — non-operative and surgical options.

78 citationsUpdated Oct 2026
Illustration: PIP Joint Arthritis

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Surgical management of PIP joint arthritis aims to relieve pain and restore function, with implant survivorship and complication rates guiding modality selection. Silicone arthroplasty remains the treatment of choice for symptomatic osteoarthritic PIP joints, demonstrating 90% implant survivorship at an average of 10 years postoperatively [9]. While effective for pain relief, silicone replacement does not improve motion or correct deformity [7]. It is also an excellent option for chronic PIP joint dislocations, improving pain and function while maintaining acceptable long-term viability [27]. Pyrocarbon arthroplasty provides excellent pain relief and increases the arc of motion by more than double the preoperative range [49]. However, clinical outcomes are variable despite substantially good survivorship [3], with 85% survival at 5 years and high patient satisfaction [25]. Approximately 1 in 5 pyrocarbon PIP joint arthroplasties requires revision surgery by 5 years, and 1 in 3 undergoes more than one operation [18]. Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty [68], though functional outcomes in trauma cases have been disappointing [2].

Surface replacement arthroplasty offers encouraging initial reports, particularly because component loosening typical of earlier designs has not been a problem [22]. The volar approach to PIP surface replacement can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [6]. In a study of 25 PIP joints placed via the volar approach, the average preoperative total arc of motion improved from 42 to 56 degrees [5]. The SLFJ implant demonstrated good pain relief and overall patient satisfaction while maintaining joint range of motion at minimum 2 years of follow-up [30]. Arthrodesis has very few contraindications and an excellent overall success rate, making it an excellent option for surgical management [10]. It serves as the ultimate salvage for failed PIP joint arthroplasty, which may require arthrodesis or even amputation [26]. PIP joint denervation provides durable, effective pain relief with high patient satisfaction despite osteoarthritis progression [13].

Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause [1, 31]. Data demonstrate an increased use of primary PIP arthroplasty for patients with osteoarthritis, whereas revision arthroplasty decreased [4]. Treatment of the long finger may be a relative contraindication to PIP joint arthroplasty [35]. Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs [59].

Anatomy & Pathophysiology

Bony Anatomy and Kinematics

The hand skeleton comprises 27 bones, 19 of which are long bones [48]. These bones are organized into five rays, each forming a polyarticulated chain of metacarpals and phalanges [48]. The proximal interphalangeal (PIP) joint functions as a simple hinge joint, permitting motion exclusively in the flexion-extension axis [97]. In full extension, joint stability is maintained by highly congruent bony architecture [97]. The internal structure and material properties of the phalanges significantly influence the magnitude and distribution of stresses within finger joints [98]. The PIP joint is prone to injury and residual deformity [34]. An extensive review of 96 PIP joint injuries identified a 30% poor recovery rate, characterized by joint instability, poor function, pain, or flexion deformities [34].

Soft Tissue Anatomy

The PIP joint is enveloped by capsuloligamentous structures, including the dorsal capsule, volar plate, and collateral ligaments [97]. Unlike the metacarpophalangeal joint, the PIP joint’s collateral ligaments remain essentially isometric throughout the arc of motion [97]. The extrinsic extensors traverse six distinct fibroosseous retinacular compartments at the wrist level [47]. The principal bony insertion for these extrinsic digital extensors is located on the dorsal proximal aspect of the middle phalanx [47]. Metacarpophalangeal joint extension is achieved through extrinsic extensor force transmitted via the sagittal bands [47]. Distal interphalangeal joint extension is accomplished through conjoined lateral bands, composed of tendinous slips from both extrinsic and intrinsic tendons [47].

Sagittal band fibers insert onto the volar proximal phalanx and the lateral borders of the volar plate [47]. These bands form a sling that transmits proximal extrinsic extensor tension to the proximal phalanx, enabling metacarpophalangeal joint extension without a direct tendinous insertion onto the proximal phalanx [47]. Rupture or attenuation of sagittal band fibers allows the extrinsic extensor tendon to sublux to the ulnar side of the metacarpal head, resulting in ulnar deviation of the finger [47]. The flexor digitorum superficialis acts as a flexor for both the proximal interphalangeal and metacarpophalangeal joints [47]. The flexor digitorum profundus inserts on the proximal volar aspect of the distal phalanx, flexing the distal interphalangeal joint as well as the proximal interphalangeal and metacarpophalangeal joints [47].

The deep head of each dorsal interosseous muscle forms a lateral tendon, or lateral band, at the level of the metacarpophalangeal joint [76]. This deep head flexes and weakly abducts the proximal phalanx while extending the middle and distal phalanges [76]. Transverse fibers arch dorsally from each lateral band to join over the dorsum of the finger, flexing the proximal phalanx [76]. Oblique fibers, also known as spiral fibers, sweep over the distal third of the proximal phalanx to insert onto the lateral tubercles at the base of the middle phalanx, thereby extending the middle phalanx at the PIP joint [76]. The lateral bands are joined by the lateral slips of the extensor tendon to form the conjoined lateral band [76]. The two conjoined lateral bands for each finger unite at the distal third of the middle phalanx to form the terminal tendon, which inserts at the base of the distal phalanx to extend it [76]. The volar interossei contribute to the ulnar lateral band of the index finger and the radial lateral band of the ring and little fingers [76].

Dorsal hand skin is thin with loose connections to deeper planes, facilitating free gliding and full flexion at the digital joints [85]. Flexion of the PIP joint may utilize the segment of loose skin immediately above the joint, providing a length gain between 0.7 and 0.9 cm [85].

Pathophysiology

Rheumatoid arthritis is characterized by inflamed, hypertrophic synovium that destroys cartilage and ligaments [33]. Progressive joint synovitis stretches the capsule, ligamentous structures, and extensor mechanism in the metacarpophalangeal and proximal interphalangeal joints, resulting in typical rheumatoid finger deformity [33]. The boutonniere deformity presents as a flexion posture of the PIP joint and a hyperextension posture of the DIP joint [71]. The inciting event for this deformity is persistent PIP joint synovitis, which causes attenuation of the central slip, transverse retinacular ligaments, and triangular ligament [71]. Weakening of these structures causes the lateral bands to subluxate volar to the axis of rotation of the PIP joint [71]. Once subluxated volar to the axis of rotation, the lateral bands function as PIP joint flexors rather than extensors [71]. With persistence of PIP joint flexion, the volar plate, collateral ligaments, and oblique retinacular ligaments become contracted, leading to a fixed joint contracture [71].

Stage 1 boutonniere deformity is classified as a passively correctable PIP joint flexion deformity of 10° to 15° (extension lag) with minimal functional loss [21]. In Stage 1, there is typically full passive PIP extension [21]. Loss of function in this stage can be attributed to limited DIP flexion [21]. The pathogenesis of PIP joint contracture is attributed to a cycle of edema, immobilization, and tissue adherence of the capsuloligamentous structures [97]. Inappropriate management of PIP joint injuries may result in chronic pain, stiffness, deformity, or premature degenerative arthritis [34]. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand [55]. The most important factor in the development of finger deformities is the changes occurring in the tendons and related structures, especially in early stages [111].

Women with hand osteoarthritis exhibit significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types [90]. People with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with controls [132]. With instruction on joint protection techniques, participants with hand arthritis made significant changes in the amount of movement used to perform tasks [132]. High-resolution magnetic resonance imaging findings raise important questions about the role of ligaments in hand osteoarthritis [62]. The pathogenesis of the early stages of osteoarthritis is poorly understood, but considerable emphasis has been placed on the role of cartilage and subchondral bone as well as soft tissue structures such as collateral ligaments and tendons [44]. Osteoarthritis is a complex disease resulting in the failure of articular cartilage due to a combination of genetic, metabolic, biochemical, and biomechanical factors [44]. Cartilage loss and reactive new bone formation at joint margins is accompanied by the proliferation of osteoarticular tissue in the capsule [44].

The PIP joint has unique anatomy that predisposes it to stiffness [97]. Understanding the mechanics of human dexterity requires an appreciation of the kinetic chains that comprise the hand and the intricate interplay of muscles and ligaments that control its movements [89]. Proper biomechanics of a joint must be restored to achieve full, functional range of motion [92]. Despite the wealth of knowledge regarding the anatomy of the PIP joint, it remains a subject of ongoing investigation, and evolving understanding of its biomechanical properties will continue to improve treatment and reconstructive designs [94].

Classification

The diagnosis of PIP joint osteoarthritis relies primarily on the clinical presentation, with radiographs serving to confirm the condition [36]. Because radiographic findings and symptoms do not correlate in PIP joint osteoarthritis, classifications and staging systems based solely on radiographs are rarely utilized [36]. However, radiographic evaluation remains critical for surgical planning, specifically regarding bone quality, defects, and cyst formation [36]. The presence of stiffness and deformity also plays a crucial role in determining indications for possible surgical treatment options [36].

PIP-Kellgren: A proposed functional-radiological classification system designed to help stratify surgical candidates and standardize severity assessment for PIP joint osteoarthritis [37].

Nalebuff: A classification system for boutonniere deformity comprising three stages based on the passive correctability of the PIP joint flexion deformity and the condition of the articular surfaces of the PIP joint [71]. Stage 1 is characterized by synovitis of the PIP joint and a slight, fully correctable extensor lag [71]. Indications for surgical treatment of Stage 1 boutonniere deformity include persistent synovitis that has failed nonsurgical treatment and deformities that interfere with activities but are passively correctable [21].

SCARF: A classification system that allows non-hand specialists to specify the type of every PIP joint dislocation [103].

Clinical Presentation

Diagnostic Criteria and Indications

Radiographic findings and clinical symptoms in PIP joint arthritis do not correlate, which is the primary reason that radiograph-based classifications and staging systems are rarely used [36]. Surgical intervention is indicated when patients present with radiological signs of PIP joint osteoarthritis, defined as Kellgren-Lawrence classification grade 2 or higher, combined with persistent pain despite at least 3 months of nonsurgical treatment [17]. Beyond pain, stiffness and deformity also serve as valid indications for surgery [17]. In clinical practice, the most common indications for initial PIP joint arthroplasty are stiffness (28%) and pain (25%) [23]. PIP joint arthroplasty should be proposed exceptionally only when PIP joint arthritis causes invalidating functional pain [11].

Clinical Findings and Symptoms

Many patients experience fewer symptoms at the end stage of PIP joint osteoarthritis than at the beginning of the disease process [36]. Following PIP joint sprains, it is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction [24]. PIP joint stiffness remains an unsolved problem in hand surgery, with a poor prognosis in complex cases even after complete arthrolysis and tenolysis [108]. In patients with trigger finger, PIP joint pain is mostly aching and felt on the palmar and dorsal aspect of the joint [51]. This pain worsens with PIP joint movement, especially when the joint is actively extended [51]. Occasionally, the pain radiates proximally [51], and patients may have additional PIP joint tenderness on palpation [51].

Radiographic Findings

The index PIP joint is often deviated to the ulnar side due to the mechanical forces generated during pinching with the thumb [36]. Radiographic evaluation of bone quality, specifically defects and cyst formation, plays a crucial role in determining possible surgical treatment options [36]. Similarly, the presence of stiffness and deformity plays a crucial role in the indication of possible surgical treatment options [36]. A proposed PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment [37].

Post-Traumatic Presentation

Fracture dislocations of the PIP joint may rapidly develop fixed deformity, leaving the patient with a poor outlook for complete correction [57]. Clinical results for PIP joint dislocations and fracture-dislocations vary and are often difficult to predict due to the complexity of fracture patterns and the potential for sub-acute or chronic presentation [107].

Investigations

Plain radiography: Patients are considered for PIP joint arthroplasty if they have radiological signs of PIP joint osteoarthritis (Kellgren-Lawrence classification ≥grade 2) in combination with pain, despite nonsurgical treatment for at least 3 months [17]. The PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment [37].

CT: High-resolution peripheral quantitative CT and microCT commonly visualize cortical breaks in MCP and PIP joints [141].

Treatment

Non-Operative

Conservative management for PIP joint arthritis includes serial casting, which is an effective method to correct flexion contractures in selected patients [28]. For Dupuytren contracture affecting the PIP joint, surgery performed better than collagenase at both early and 2-year follow-up [8]. However, collagenase treatment yields variable results; clinical success occurred in 27% of joints after one injection and 34% after the last injection, while clinical improvement was observed in 49% and 58% of joints, respectively [43]. Range of motion for PIP joints treated with collagenase increased from 51 to 71 degrees after the first injection and to 75 degrees after the last injection [43]. External fixation serves as a simple and effective treatment modality for chronic traumatic PIP joint contractures, offering good predictable medium- to long-term results [40].

Operative

Indications: Surgical intervention is appropriate for symptomatic PIP joint degenerative, post-traumatic, or inflammatory arthritis given the proper clinical setting [29]. The TACTYS prosthesis should be proposed exceptionally if PIP joint arthritis causes invalidating functional pain [11]. Indications for the PIP-SRA include primary degenerative osteoarthritis or post-traumatic arthritis in elderly, less-active patients who desire to maintain PIPJ motion and avoid arthrodesis [58]. The SR PIP implant is indicated for moderate- to high-demand patients with pain due to osteoarthritis, posttraumatic arthritis, or rheumatoid arthritis without major bone loss [116]. Appropriate use of arthroplasty and arthrodesis requires careful consideration of the patient's needs [117].

Contraindications: Use of the PIP-SRA is not indicated in patients with rheumatoid arthritis or other inflammatory arthritis because of the effect of these arthritides on soft-tissue integrity [58]. Contraindications for PIP-SRA include current or chronic infection, loss of extensor mechanism or flexor tendon function, poor soft-tissue envelope, absent collateral ligament function, and incompetence of the PIPJ volar plate [58]. Relative contraindications include the presence of a static swan-neck or boutonnière deformity [58]. For SR PIP arthroplasty, coronal angulation of greater than 15° is a contraindication [116]. PIP joint arthroplasty pre-requisites are intact tendons and at least some residual joint stability [138]. Corrections of a lateral deviation beyond 30° are difficult and likely to fail in PIP arthroplasty [138].

Surgical Approach / Technique: The volar approach to PIP surface replacement arthroplasty can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis [6]. Surgical treatment for congenital PIP joint contracture should proceed in a stepwise manner, with goals of placing the digit in a more functional and extended position while maintaining finger flexion [39]. Persistent synovitis leading to a progressive boutonniere deformity can be treated with surgical synovectomy [21]. Open reduction of chronic untreated PIP joint dislocations can successfully achieve a functional range of motion with a stable joint [69]. Periosteum interposition after dorsolateral dislocation of the PIP joint resulted in full range of motion and no pain or laxity two months after surgery [19].

Implant Selection: Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function [15]. Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief [145]. With proper indications, careful surgical technique, and a supervised therapy protocol, proximal interphalangeal joint silicone arthroplasty is a useful operation for pain relief and functional gain [129]. Osseointegrated prostheses for PIP joint replacement provide good pain relief, high patient satisfaction, and a significant improvement of both active ROM and hand function [139]. The SR PIP implant is an effective alternative to fusion in the index PIP joint when motion is desired [116].

Other Considerations: Patients should be advised that PIPJ ROM deteriorates over time following pyrolytic carbon hemiarthroplasty [14]. Total joint arthroplasties of the hand have a poorer record compared with large joints of extremities, related to problems inherent to the hand including joints situated within a complex kinetic chain, multiple parallel rays, and small size [60]. Denervation is an effective treatment for painful PIP osteoarthritis, providing lasting pain relief while conserving range of motion [115].

Complications

Arthroplasty Complications

Infection (PJI): Periprosthetic joint infection is uncommon following MCP or PIP arthroplasties [32].

Implant Failure: All cemented Biomeric devices failed through the elastomer hinge at an average of 2.25 years after operation [70]. The LPM PIPJ prosthesis demonstrated a revision rate of 29%, with a further 20% rate of adverse clinical and radiological outcomes at a maximum follow-up of 6 years [112].

Aseptic Loosening: Radiographically evident bone resorption adjacent to the silicone implant was progressive over time [70]. Specifically, 35% of implants followed-up longer than 2 years demonstrated periarticular erosion, and 20% followed-up beyond 4 years had extensive endosteal resorption along the intramedullary prosthetic stems [70].

Periprosthetic Fracture: Intraoperative fractures occur in about 5% of PIP joint arthroplasties [105]. These events do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications [105].

Injury and Non-Arthroplasty Complications

Stiffness / Arthrofibrosis: Pain or locking from trigger finger may lead to secondary contracture of the PIP joint [51].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for desk work, driving, or light activities of daily living.

Full activity (months): The provided evidence does not specify a month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: Maintaining motion and function following trauma and/or surgery of the PIP joint remains very challenging [20]. 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 [150].

Functional milestones: Improvement in PIP joint active extension from orthotic intervention did not correlate with increased function as perceived by the patient [150].

Other Considerations: Reoperations following primary nonconstrained PIP joint arthroplasties are common [1], with extensor mechanism dysfunction being the most frequent cause [1]. Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years [18], and approximately 1 in 3 will undergo more than 1 operation by 5 years [18]. PIP joint range of motion deteriorates over time following pyrolytic carbon hemiarthroplasty [14]. Additionally, PIP range of motion after surface replacement arthroplasty through a volar approach has a tendency to deteriorate with longer follow-up [73].

Key Evidence

  • [L4] Reoperations following primary nonconstrained PIP joint arthroplasties are common, with extensor mechanism dysfunction being the most frequent cause. [1] (10.1016/j.jhsa.2011.06.002)
  • [L4] The subjective and objective functional outcomes in 5 patients more than 1 year after pyrolytic carbon PIP joint arthroplasty for PIP joint trauma were disappointing. [2] (10.1016/j.jhsa.2006.07.017)
  • [L4] Despite substantially good survivorship, clinical outcomes for PIP joint replacements with pyrocarbon implants are variable. [3] (10.1302/2058-5241.2.160041)
  • [L4] The data demonstrate an increased use of primary PIPA utilization for patients with OA, whereas revision PIPA decreased. [4] (10.1177/1558944719837009)
  • [L4] In a study of 25 PIP joints placed through the volar approach during a 5-year period with an average follow-up of 33 months, the average preoperative total arc of motion improved from 42 to 56 degrees. [5] (10.1097/bth.0b013e31818c0f71)
  • [L4] The volar approach to PIP SRA can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis. [6] (10.1016/j.jhsa.2011.03.003)
  • [L4] Silicone replacement of the PIP joint is effective in providing relief of pain from arthritis but does not provide improvement in motion or correction of deformity. [7] (10.1016/j.jhsa.2004.03.008)
  • [L3] Surgery performed better than collagenase at early and 2-year follow-up in PIP joints and similarly in MCP joints. [8] (10.1007/s00402-018-3034-6)
  • [L4] With an implant survivorship of 90% at average of 10 years postoperatively, silicone implant arthroplasty remains the treatment of choice for the symptomatic osteoarthritic PIP joint. [9] (10.1016/j.jhsa.2013.11.008)
  • [L5] PIPJ arthrodesis has very few contraindications, with an excellent overall success rate, making it an excellent option for surgical management of PIPJ arthritis. [10] (10.1016/j.hcl.2017.12.007)
  • [L4] It should be proposed exceptionally if the PIP joint arthritis causes invalidating functional pain. [11] (10.1177/15589447211030962)
  • [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. [13] (10.1016/j.jhsa.2026.01.033)
  • [L4] Patients should be advised that PIPJ ROM deteriorates over time. [14] (10.1016/j.jhsa.2023.11.007)
  • [L4] Treatment of MCP and PIP osteoarthritis with an anatomically neutral implant can provide reliable, long-term pain relief and maintenance of function. [15] (10.1016/j.jhsa.2008.11.005)
  • [L3] [17] (10.1177/15589447221141485)
  • [L4] Approximately 1 in 5 PIP joint arthroplasties with a pyrocarbon implant will require revision surgery by 5 years, and 1 in 3 will undergo more than 1 operation. [18] (10.1016/j.jhsa.2018.06.020)
  • [L5] Two months after surgery, he demonstrated a full range of motion, and reported no pain or laxity of the PIPJ. [19] (10.1177/1753193420937563)
  • [L5] Maintaining motion and function following trauma and/or surgery of the PIP joint remains very challenging. [20] (10.1016/j.hcl.2017.12.003)
  • [L5] [21] (10.1016/j.jhsa.2011.05.029)
  • [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. [22] (10.5435/00124635-200309000-00002)
  • [Paper] [23] (10.1055/s-0040-1709088)
  • [L4] It is common for patients to experience a prolonged duration of swelling, stiffness, and dysfunction following PIP joint sprains. [24] (10.1016/j.jhsa.2023.01.025)
  • [L4] The survival of pyrocarbon PIP joint arthroplasty was 85% at 5 years of follow-up, with high patient satisfaction. [25] (10.1016/j.jhsa.2012.02.012)
  • [L5] Ultimate salvage for the failed PIP joint arthroplasty may require arthrodesis or even amputation. [26] (10.1016/j.hcl.2017.12.011)
  • [L5] Silicone arthroplasty is an excellent option for the management of chronic PIP joint dislocations to improve pain and restore function while maintaining acceptable long-term viability. [27] (10.1097/bth.0b013e31820f8b53)
  • [L4] SC is an effective method to correct flexion contractures in PIP joints in selected patients with arthritis. [28] (10.1016/j.jht.2015.11.005)
  • [L4] PIPJ implant arthroplasty is a good and reliable option for symptomatic PIPJ degenerative, post-traumatic or inflammatory arthritis given the proper clinical setting. [29] (10.1177/17531934241265837)
  • [L4] The minimum 2 years of follow-up evaluation of the SLFJ implant PIP joint arthroplasty demonstrated good pain relief and good overall patient satisfaction while maintaining joint range of motion. [30] (10.1177/1558944717726136)
  • [L4] Reoperations following primary non-constrained PIP arthroplasties are common. [31] (10.1016/s0363-5023(11)60049-x)
  • [L4] PJI is uncommon after MCP or PIP arthroplasties. [32] (10.1016/j.jhsa.2024.12.008)
  • [L4] [33] (10.1097/bth.0b013e31818ee8d4)
  • [L5] [34] (10.1016/j.hcl.2006.05.003)
  • [L1] Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. [35] (10.1177/1558944718791186)
  • [L5] [36] (10.1016/j.hcl.2017.04.002)
  • [L4] The proposed PIP-Kellgren functional-radiological classification system may help stratify surgical candidates and standardize severity assessment. [37] (10.1016/j.jhsg.2025.100911)
  • [L5] Surgical treatment should proceed in a stepwise manner, and patient expectations must be managed preoperatively with the goals of placing the digit in a more functional and extended position while maintaining finger flexion. [39] (10.1016/j.hcl.2017.12.013)
  • [L4] External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results. [40] (10.1016/j.jhsa.2013.07.007)
  • [L2] [43] (10.1016/j.jhsa.2015.02.018)
  • [L5] [44] (10.1016/j.jhsa.2010.09.003)
  • [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. [49] (10.1177/1753193411434053)
  • [L4] [51] (10.1177/1753193418809771)
  • [L5] Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. [55] (10.1177/1753193414559464)
  • [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. [57] (10.1016/j.hcl.2012.05.036)
  • [L4] [58] (10.1016/j.jhsa.2007.04.012)
  • [L3] Minimizing postoperative complications after MCP and PIP joint arthroplasty is one avenue to decrease health care costs. [59] (10.1016/j.jhsa.2019.11.002)
  • [Paper] Total joint arthroplasties of the hand have a poorer record compared with large joints of extremities, related to problems inherent to the hand including joints situated within a complex kinetic chain, multiple parallel rays, and small size. [60] (10.1097/00130911-200109000-00003)
  • [L4] The findings also raise important questions about the role of ligaments in hand OA. [62] (10.1002/art.21210)
  • [L4] Pyrocarbon hemiarthroplasty appears to be a viable alternative to total joint arthroplasty in the treatment of PIP joint arthritis. [68] (10.1016/j.jhsa.2014.12.016)
  • [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. [69] (10.1016/j.jhsa.2020.07.002)
  • [L4] [70] (10.1016/0363-5023(90)90096-a)
  • [L5] [71] (10.5435/00124635-199903000-00002)
  • [L4] PIP ROM after SRA through a volar approach has the tendency to deteriorate with a longer follow-up. [73] (10.1177/1558944718787332)
  • [Paper] Understanding the mechanics of human dexterity requires an appreciation of the kinetic chains that comprise the hand and the intricate interplay of muscles and ligaments that control its movements. [89] (10.1053/jhsu.2002.28764)
  • [L3] Women with hand osteoarthritis exhibited significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types. [90] (10.1016/j.jht.2024.02.005)
  • [L5] Proper biomechanics of a joint must be restored to achieve full, functional range of motion. [92] (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. [94] (10.1016/j.hcl.2017.12.002)
  • [L5] [97] (10.1016/j.jhsa.2015.06.118)
  • [L5] The internal structure and material properties of the phalanges were found to play a significant role in both the magnitude and distribution of stresses. [98] (10.1007/s11552-012-9430-4)
  • [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. [103] (10.1016/j.jos.2019.08.007)
  • [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. [105] (10.1016/j.jhsa.2015.06.101)
  • [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. [107] (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. [108] (10.1177/17531934221143690)
  • [L4] The most important factor in the development of finger deformities is the changes occurring in the tendons and related structures, especially in early stages. [111] (10.2106/00004623-195739030-00006)
  • [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. [112] (10.1177/1753193408094920)
  • [L4] Denervation is an effective treatment for painful PIP osteoarthritis, providing lasting pain relief while conserving range of motion. [115] (10.1016/j.otsr.2021.102976)
  • [L4] [116] (10.1016/j.jhsa.2014.11.015)
  • [L5] Appropriate use of arthroplasty and arthrodesis for affected joints requires careful consideration of the patient's needs. [117] (10.1016/j.hcl.2010.09.003)
  • [L4] With proper indications, careful surgical technique, and a supervised therapy protocol, proximal interphalangeal joint silicone arthroplasty is a useful operation for pain relief and functional gain. [129] (10.1016/s0363-5023(05)80070-x)
  • [L3] This study demonstrated that people with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with the controls, and that with instruction on joint protection techniques, participants made significant changes in the amount of movement used to perform tasks, which supports a proof of principle of joint protection. [132] (10.1016/j.jht.2020.10.010)
  • [L5] [138] (10.1302/2058-5241.4.180042)
  • [L4] This study shows that osseointegrated prostheses for PIP joint replacement provide good pain relief, high patient satisfaction, and a significant improvement of both active ROM and hand function. [139] (10.1053/jhsu.1999.0267)
  • [L4] Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and microCT. [141] (10.1186/s12891-016-1148-y)
  • [L4] Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. [145] (10.1177/1558944718769427)
  • [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. [150] (10.1016/j.jhsa.2015.01.005)

See Also

References

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