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mtomaino 04-16-2012 02:54 PM

Question about finger PIP joint replacement
I received this question recently and wanted to address:

I want to know Dr. Tomaino\'s success with middle finger PIP joint replacement (how many such surgeries a year, and what average longevity of success afterwards?), and esp. his opinion regarding projected success with my own condition -- I injured such joint in 9/07, resulting in boutennaire deformity, and had surgery. A second surgery was required to remove scar tissue on the inside (palm side) of the joint, and then a third surgery to do a trigger release. I have great flexion (but about 15% lag in the DIP),but the PIP joint is now severely disintegrated from arthritis, and the finger wraps over my ring finger from the PIP up (is painful and stiff, and difficult to use). If the ligament is severely stretched out and/or the tendon slipped again or is otherwise damaged, what are Dr. Tomaino\'s projections for success with having the PIP joint replaced? (When I force the flexion, the DIP also feels stiff). -- Thank you so much in advance for your response.

Thanks for your question. It sounds as though your 3 previous surgeries were successful in restoring functional range of motion---but that now the PIP joint is severely arthritic and painful. The long finger PIP joint can be replaced---but it can also be fused. The decision to do one over the other, in general, relates to demands, the available bone stock, and the fucntion of the extensor tendon and flexor tendons. It sounds as though you have functional flexion and extension, and that the pain from the joint deterioration is the primary problem for you now. In general, arthroplasty for rheumatoid related arthritis with a boutonierre deformity is not very successful at improving motion. But, if your PIP joint lag and /or contracture have responded to previous surgery, you may be a candidtate for replacement. Although I have not replaced a PIP joint in the aftermath of a Boutonierre reconstruction, it does not sound as though there is a contraindication to you considering this.
Ofcourse, your doctor seeing you, understanding your expectations etc will be a critical part of any recommendation. But replacement sounds feasible---just may not necessarily be advisable. I do roughtly 5-10 PIP joint arthroplasty procedures a year and in my career have performed about 150. Best to you.

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