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PIPJ Arthritis

Finger joint arthritis
(PIPJ arthritis)

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  • It occurs when the cartilage in the finger joint wears out.

  • Eventually  ‘bone on bone’  articulation occurs and bone spurs develop.

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  • Osteo arthritis is mostly genetic (runs in families)

  • Injuries that cause instability or breaks that result in a step in the joint surfaces both can cause arthritis in the long term

  • Inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis etc. can also result in worn out joints.

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  • The joints become larger.

  • The joints commonly ache and swell.

  • The fingers become stiff, especially after a period of rest. Often it is difficult to make a full fist.

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  • Avoid activities that hurt and find other ways to do them

  • Take simple pain relief (such as paracetamol) and consider taking an anti inflammatory.

  • An steroid injection into the worn joint can sometime relieve pain from acute flare ups.

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  • When non operative treatment is unsuccessful and

  • pain and weakness in the hand:

  • stop you from doing the ‘things that you have to do’  such as getting dressed, making a meal, driving a car, or getting a good night’s sleep

  • and/or the ‘things that you love to do’ in life such as fishing, crafting, or holding a book to read.

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  • This kind of surgery can be done under local anaesthetic (numbing the finger only) in  hospital.

  • The anaethetist usually administers sedation (a ‘twilight anaesthetic’)

  • Antibiotics is usually administered at the time of surgery, but does not have to be continued after surgery.

  • It is common to go home within a few hours of the surgery (day surgery)

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  • The operation is done through a curved incision on the back of the finger.

  • The worn out joint surfaces and bone spurs are removed

  • The surfaces are replaced with a metal and plastic (polyethylene) prosthesis.

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In Hospital

  • The finger is placed in a plaster or thick bandage.

  • It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling

  • Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’,  than ‘to catch’ up when it is severe.

  • If the dressing feels to tight, ask to have the bandages cut and even remove the plaster if pain form a tight cast is severe.

  • It is usual to leave hospital the same day as the surgery.

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At Home

  • Continue to elevate your arm until swelling in your fingers subside.

  • Keep the wound dry, covered and clean.

  • Make and appointment with a hand therapist (within a 3-5 days)

  • A combined appointment with hand therapy and your surgeon is usually arranged for about 2 weeks after surgery.

  • Please do not drive before speaking to hand therapy or a doctor.

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  • A splint is usually used for about 6 weeks

  • A hand therapist will show you how to do gentle range of motion exercises with the help of a splint in this time.

  • Most moderately heavy activities can usually be achieved by 3-4 months, but scarring around the finger can take 6 -9months to become completely comfortable

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  • Time frames

  • Self care (washing, dressing, eating) with the operated hand – usually around 2 weeks (a splint is still needed)

  • Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usualy 4-8 weeks post surgery)

  • Golf, fishing, cycling etc.: usually around 3-4 months, but it can be longer (6 months)

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  • Infection occurs rarely (1% of the time), but can be severe. It may need further operations, weeks in hospital.  It can lead to a poor outcome.

  • Damage to the nerves or blood vessels to the fingers can (rarely) occur. It can lead to numbness and ongoing pain.

  • Severe scarring and stiffness can occur leading to a very stiff finger.

  • The joint can become unstable, it can wear out, become loose and the bone around the implant can break.

  • Repair of the tendon that straightens the finger (which is a routine part of the surgery) can fail, resulting in a finger that does not straighten out completely.

  • The complications mentioned above are rare, but may necessitate revision surgery, fusion of the joint, or (in extreme cases) amputation of the finger.

  • Very rarely (around one in a thousand) a severe pain reaction(CRPS) can develop, which can be disabling for years.

  • An anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

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  • Finger joint replacement has a high success rate and most patients are very happy.

  • Pain is usually significantly improved, if not cured completely

  • Mobility in the finger is usually improved compared to before the operation, although it will not be normal.

  • The joints replacements are usually expected to last at least 10 years.

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