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PIPJ (middle knuckle of the finger) replacement

Joint replacements in the hand are generally performed for arthritis. It may be that in the future they are performed for unfixable fractures but at the moment that is not the case. Arthritis in the PIPJ's which is the middle knuckle of the finger involves pain, stiffness and sometimes deformity. Pain, stiffness and deformity can all be corrected by joint replacement. The big advantage of joint replacement over joint fusion is that some movement will be maintained. It is important that the operation is not carried out to increase range of movement it may do so but no necessarily. It has to be said that these still are experimental and there are no long term results particularly of joint replacements of the PIPJ. There are 10 year results for the MCPJ (first knuckle of the finger) but not the PIPJ. Mr Field has carried out 25 PIPJ replacements so far.


ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

A longitudinal cut is made in the skin over the back of the joint. Skin flaps are raised and a longitudinal incision is made in the tendon. The joint is exposed and flexed. A guide wire is then passed up the proximal phalanx (first bone in the finger) from the joint back towards the hand. This guide allows a cutting jig to cut the end of the proximal phalanx. The cut is done in such a way that the collateral ligaments around the side of the joint are maintained. The inside of the bone (the marrow cavity) is then reamed out using sized reamers. A similar process is used to cut the base of the middle phalanx (the middle bone of the finger) and similarly this is reamed out using sized reamers to the appropriate size. A trial prosthesis is then inserted to see if this fits with satisfactory stability and if it does then the trial prosthesis is taken out and replaced the pre-packaged real prosthesis.

Prior to this part of the tendon is attached to the base of the middle phalanx by using bone sutures and the prosthesis is then inserted, joint reduced, extensor tendon closed and the skin is closed over the back of the hand.



POST OPERATIVELY

The finger is kept as straight as possible with a splint which may extend down the arm. The finger is elevated overnight. Intravenous antibiotics are given to prevent infection. The finger is kept straight in the splint for a period of 2 weeks and the splint, dressing and stitches are removed. Physiotherapy are commenced. There will be a splint used on the finger at night for a period of 6 weeks with a gradual mobilisation period over a period of 6 weeks with the physiotherapist.

COMPLICATIONS

The same for any joint replacements whether it be hip, knee or finger.
  1. Infection - this is incredibly rare and is rarer in the hand than the hip or the knee but is probably between 1 - 2%.
  2. Dislocation - of the MCPJ's is less common than the PIPJ replacements and probably occurs in 5 % of cases. If the joint does dislocate it will need a further operation to relocate it.
  3. Loosening - all artificial joints can loosen but if they loosen they become painful and the operation may need to be re-done. The rate of loosening is 1 - 2 %.
  4. Complex regional pain syndrome - this is a bad reaction that can occur after any operation. The chances of developing it are 1 - 5%.