Joint replacement: Osteotec silicone PIP joint replacement
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This is a detailed step by step instruction for a Middle finger Proximal inter-phalangeal joint (PIPJ) replacement with the Osteotec silastic PIP joint implant, uisng a dorsal midline approach.
This is a procedure usually performed for osteoarthritis of the PIPJ with stable collateral ligaments. It can also be performed for post-traumatic or well controlled inflammatory arthritis as long as the bone stock and soft tissue stability can support the joint. As this is a one piece joint replacement a small amount of joint instability can be tolerated pre-operatively compared with 2 component joint replacements.
Following a period of 1 week in plaster cast the patient then starts mobilisation with a Bedford finger splint and is provided with a night resting splint at 30 degrees metacarpal-phalangeal joint (MCPJ) flexion and straight PIPJs. The patient should achieve close to their pre-operative range of movement with minimal pain by 6 weeks and at this point should start strengthening exercises. The joint will always remain enlarged and swollen after the procedure compared to the pre-operative state although the majority of post operative swelling will resolve by 3 months.
The silastic joint replacements will usually last beyond 5 years (see results section for further details). One major advantage of the silastic versus the metal and poly implants is their ease of revision as they are not cemented. Another advantage is that if the implant itself fractures on occasion the digit may still continue to be functional with a silastic implant.
There are a number of small joint replacements manufactured for the hand which are very similar to the Osteotec silastic PIPJ replacement. The wide range of sizes and reamers on one tray however is a significant thing in the hand. This allows the surgeon the ability with a single kit to replace the MCPJ, PIPJ and distal inter-phalangeal joints (DIPJ) and deal effectively with a wide range of phalangeal sizes.
Readers will also find of interest the following techniques on OrthOracle: Stryker SR MCPJ Cemented Joint replacement, PIP joint replacement (Middle finger): Stryker SR Metal on Poly implant, Fractional Tendon Lengthening and Swanson Silastic Metacarpophalangeal Joint Replacement (Wright Medical) for Spasticity
Author – Mr Mark Brewster
Royal Orthopaedic Hospital, Birmingham
Author:Mr Mark Brewster FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham, UK.