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Rheumatoid Arthritis: PIP Joint


- See:
        - Rheumatoid Boutonniere
        - RA
        - Swan Neck Deformity

- Arthrodesis: of PIP
    - expect improved key pinch strength w/ fusion of PIP joint of index finger;
    - arthroplasty of PIP joint of index is least successful results;
    - technique:
            - involves resection of joint surfaces are resected back to medullary bone, tightly coapted, and fixed w/ K wires;
            - bone grafting is used when necessary.
            - consider fusion w/ Herbert screw;
    - joints fused within six weeks and required only minimal external protection;

- Arthroplasty: of PIP
    - silicone arthroplasty may be used for ulnar digits;
    - ROM of 50-60 deg w/ satisfactory pain relief can be expected;
    - complications:
           - poor flexion following PIP joint arthroplasty (etiology);
                 - insertion of prosthesis which is to large;
                 - shortening of dorsal capsule closure;
                 - improper bone cuts
                 - flexor tenosynovitis
                 - volar plate adherence;

- Synovectomy of PIP joint:
    - indicated for isolated PIP joint synovitis, not for multiple joint involvement;
    - may prevent progressive deformity



Stiffness of the proximal interphalangeal joints in rheumatoid arthritis. The role of flexor tenosynovitis.

Resurfacing arthroplasty versus silicone arthroplasty for proximal interphalangeal joint osteoarthritis.