Severe pain from arthritis in your middle knuckle (PIP joint) may require replacement (arthroplasty). Silicone replacements are the most common. They tend to have the best results and typically last longer than 10 years.

Proximal interphalangeal (PIP) joint replacement, known as PIP arthroplasty, is surgery to replace a damaged PIP joint with an artificial one to relieve pain and restore movement. The PIP joint is in the middle of your finger and is responsible for bending and extending.

The PIP joint is a common site for osteoarthritis, the most common form of arthritis. Osteoarthritis occurs due to the gradual wear to a joint and affects more than 32 million U.S. adults.

This article will provide an overview of PIP joint replacements, including the procedure, benefits, risks, types of PIP joint replacements, and who’s a good candidate for this type of surgery.

If you have debilitating pain in your PIP joint and other treatments don’t help, a doctor might recommend PIP joint surgery.

Such pain is a common symptom of osteoarthritis, which can also cause joint deformity and loss of motion. PIP joints are also common sites of pain in people with rheumatoid arthritis, an autoimmune condition.

You might also injure your PIP joint. According to 2018 research, athletes often overlook PIP joint injuries, which can lead to complications like post-traumatic arthritis.

PIP joint replacement location in the finger, connecting the proximal and middle phalangesShare on Pinterest
Illustrated by Jason Hoffman

A surgeon may discuss one or more options for replacement materials based on your health history and the range of movement you need for routine activities. The goal of an implant is to restore your functional range of motion, wear well over the long term, and allow for a simple implant surgery.

Silicone

Silicone is the most popular implant material used for PIP joint arthroscopy. This type of implant results in substantially reduced pain but hasn’t been as successful in improving range of motion.

Metal

A previously designed metal-plastic implant was found to be unstable in long-term studies. Made of a cobalt-chromium and metal-backed polyethylene-titanium combination, this type of implant provided less range of motion than other implants. This type didn’t last as long before requiring a second surgery for replacement.

Pyrocarbon

Pyrocarbon implants, also known as pyrolytic carbon implants, are usually made from high strength graphite, which is carbon based. These implants can withstand high strain without breaking or fracturing.

Overall, research suggests that pyrocarbon implants have relative success with pain improvement but aren’t as reliable at restoring range of motion. According to a 5-year follow-up study, their risk of causing side effects is as high as 68%.

Ceramic

Ceramic implants are usually coated with a mineral to help prevent the implant from loosening. But they’ve had poor results in studies, showing high rates of side effects and persistent squeaking.

Which PIP joint replacement type is best?

Studies suggest that silicone implants provide the best range of motion and the most pain relief with the lowest reoperation rate.

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An orthopedic surgeon is a specialist who performs operations to treat conditions of the bones, joints, ligaments, tendons, and muscles. An orthopedic surgeon may perform PIP joint arthroplasty using a dorsal, volar, or lateral approach.

The dorsal approach is the most common. The volar approach may have some advantages but is more technically demanding, according to a 2019 review. Read on to learn more about each of these approaches.

Dorsal

The dorsal approach involves making an incision directly down the length of the joint on the top side of the finger (opposite of the palm side). Using this approach preserves blood flow well and prevents scarring. The drawback is that all scars, through layers of skin, tendon, and muscle, are along the same line.

Volar

The volar approach involves making a diamond-shaped incision on the palm side of the finger. A doctor may recommend this surgery for certain complex fractures or dislocations.

Lateral

The lateral approach involves making an incision along the side of the finger. A doctor may recommend this approach when there’s a fracture of the condyle, or end of the finger bone, or certain other types of fractures. The drawback is that it doesn’t expose the far side of the joint.

Recovery depends on the surgical approach.

If you’ve had a dorsal arthroplasty, you can’t move your finger for the first 4 days after surgery. The surgeon will send you home with a splint to wear for 4 to 6 weeks.

If you’ve received a lateral or volar arthroplasty, you may be allowed to move your finger sooner, though splinting is still required at night for the first several weeks. The surgeon may require buddy taping to the next finger for at least 2 months.

Some of the risks of PIP joint arthroplasty include:

  • implant squeaking
  • implant dislocation
  • joint stiffness
  • implant loosening
  • joint deformity
  • infection

Silicone is the most commonly used replacement implant and has good outcomes, according to one 2019 study. When asked if surgery helped, 86% of individuals replied positively.

Doctors often ask you to rate your pain on a scale of 1 to 10, with 10 being the worst pain you’ve ever felt. In the 2019 study mentioned above, researchers found that participants rated their pain at an average of 7.4 out of 10 before PIP joint arthroplasty but rated their pain at only 1.9 after surgery.

But not everyone experiences a significant reduction in pain after PIP joint arthroplasty. Because of how the hand moves and its frequent use in daily activities, having this type of surgery doesn’t always offer an improvement compared with not having surgery.

A 2022 study found that only half of the people who had PIP joint replacements had a clinically significant reduction in pain within the first year.

Below are answers to some of the most frequently asked questions about PIP joint arthroplasty.

How long do PIP joint replacements last?

When using silicone, 80% to 90% of implants last at least 8 to 10 years. The index finger is at the highest risk of needing revision surgery due to its use in gripping.

How much does PIP joint arthroplasty cost?

With a doctor’s recommendation, many insurance plans will cover some or all of the surgery’s expenses, including joint replacement. Medicare and Medicaid may cover the cost of PIP joint arthroplasty and rehabilitation services prescribed by a doctor.

According to Medicare.gov, the average out-of-pocket cost for PIP joint replacement procedures is between $979 and $1,436 per joint, depending on the type of facility in which you have the procedure and if you have secondary insurance.

Who should not undergo PIP joint arthroplasty?

Younger patients may not be good candidates for PIP joint arthroplasty due to the relatively high reoperation rates for this surgery. A surgeon can discuss the best options based on your age, activities, and the level of stiffness in your finger.

PIP joint arthroplasty is surgery to replace a joint damaged by arthritis with an artificial joint. The goal is to relieve pain and restore range of motion for the long term.

Depending on your situation, a surgeon can choose from several kinds of implants and three surgical approaches. They’ll discuss these will you before the surgery to determine the best long-term result.

Recovery from PIP joint arthroplasty requires immobilization for several days and a splint for weeks to months. You can also expect the doctor to recommend physical or occupational therapy for your hand.