Joint replacement arthroplasty: Is it ever indicated in PIP joint fracture-dislocations?

Reconstruction of the proximal interphalangeal (PIP) joint in the setting of post-traumatic joint arthritis is a challenging problem. When there is little range of motion preoperatively within the PIP joint, arthrodesis can be performed. Amputation can be offered in the setting of a stiff painful finger, but is generally not the first-line treatment and is rather a salvage procedure in the setting of a failed joint reconstruction. In patients wishing to maintain some range of joint motion and avoid fusion, PIP joint reconstruction can be performed with a variety of techniques including vascularized toe joint transfer, autologous non-vascularized hemi-hamate transfer, and replacement joint arthroplasty. A variety of materials have been tried for PIP joint arthroplasty including silicone [1], titanium [2], cobalt, chrome, and polyethylene [3]. While silicone PIP arthroplasty has the longest track record within the United States, its nonanatomic design, limited durability, and limited stability make it a less than ideal choice for younger, more active patients. New options for PIP joint arthroplasty include the use of pyrocarbon. This chapter will examine the use of pyrocarbon arthroplasty following PIP trauma.