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Complications after surface replacing and silicone PIP arthroplasty: an analysis of 703 implants



The aim was to analyse complications after surface replacing and silicone proximal interphalangeal (PIP) joint arthroplasty.

Materials and methods

All complications, reoperations (subsequent intervention without implant modification) and revisions (subsequent surgery with implant modification or removal) were extracted out of our registry for two cohorts: (1) Patients who received a surface replacing arthroplasty at the PIP joint using the CapFlex-PIP prosthesis and (2) patients who received a PIP silicone implant. Furthermore, radiographs were evaluated for deviations from the longitudinal finger axis.


In our registry, 279 surface replacing implants and 424 silicone implants have been documented. The overall complication rate was 20% for surface replacements and 11% for silicone arthroplasties (p ≤ 0.01) with soft tissue-related events being the most prevalent in both groups. Reoperations were significantly more frequent after surface replacement (5.4%) than silicone arthroplasty (0.5%; p ≤ 0.001), while the revision rates did not differ significantly (4.4% and 3.3%, respectively; p = 0.542). Postoperative axis deviations were significantly less frequent in the surface replacement group (19% versus 58% for silicone arthroplasty; p ≤ 0.001).


We recommend using a surface replacing implant in fingers with preoperative axis deviations and correctable anatomical situation, bearing in mind the higher risk of a second surgery. However, treatment outcomes also need to be considered before choosing one implant over another.

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  1. Bales JG, Wall LB, Stern PJ (2014) Long-term results of Swanson silicone arthroplasty for proximal interphalangeal joint osteoarthritis. J Hand Surg Am 39(3):455–461

    Article  Google Scholar 

  2. Benchimol EI, Smeeth L, Guttmann A et al (2015) The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS medicine 12(10):e1001885

    Article  Google Scholar 

  3. Billig JI, Nasser JS, Chung KC (2020) National prevalence of complications and cost of small joint arthroplasty for hand osteoarthritis and post-traumatic arthritis. J Hand Surg Am 45(6):553.e1-e12

    Article  Google Scholar 

  4. Bodmer E, Marks M, Hensler S, Schindele S, Herren DB (2020) Comparison of outcomes of three surgical approaches for proximal interphalangeal joint arthroplasty using a surface-replacing implant. J Hand Surg Eur 45(6):608–614

    Article  Google Scholar 

  5. Ceruso M, Pfanner S, Carulli C (2017) Proximal interphalangeal (PIP) joint replacements with pyrolytic carbon implants in the hand. EFORT Open Rev 2(1):21–27

    Article  Google Scholar 

  6. Chamay A (1988) A distally based dorsal and triangular tendinous flap for direct access to the proximal interphalangeal joint. Ann Chir Main 7(2):179–183

    CAS  Article  Google Scholar 

  7. Chan K, Ayeni O, McKnight L, Ignacy TA, Farrokhyar F, Thoma A (2013) Pyrocarbon versus silicone proximal interphalangeal joint arthroplasty: a systematic review. Plast Reconstr Surg 131(1):114–124

    CAS  Article  Google Scholar 

  8. Daecke W, Kaszap B, Martini AK, Hagena FW, Rieck B, Jung M (2012) A prospective, randomized comparison of 3 types of proximal interphalangeal joint arthroplasty. J Hand Surg Am 37(9):1770–1779

    CAS  Article  Google Scholar 

  9. Foliart DE (1995) Swanson silicone finger joint implants: a review of the literature regarding long-term complications. J Hand Surg Am 20(3):445–449

    CAS  Article  Google Scholar 

  10. Forster N, Schindele S, Audigé L, Marks M (2018) Complications, reoperations and revisions after proximal interphalangeal joint arthroplasty: a systematic review and meta-analysis. J Hand Surg Eur 43(10):1066–1075

    Article  Google Scholar 

  11. Harris CA, Shauver MJ, Yuan F, Nasser J, Chung KC (2018) Understanding patient preferences in proximal interphalangeal joint surgery for osteoarthritis: a conjoint analysis. J Hand Surg Am 43(7):615–624.e4

    Article  Google Scholar 

  12. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  Google Scholar 

  13. Herren D (2019) The proximal interphalangeal joint: arthritis and deformity. EFORT Open Rev 4(6):254–262

    Article  Google Scholar 

  14. Herren DB (2017) Current European practice in the treatment of proximal interphalangeal joint arthritis. Hand Clin 33(3):489–500

    Article  Google Scholar 

  15. Herren DB, Keuchel T, Marks M, Schindele S (2014) Revision arthroplasty for failed silicone proximal interphalangeal joint arthroplasty: indications and 8 year results. J Hand Surg Am 39(3):462–466

    Article  Google Scholar 

  16. Herren DB, Schindele S, Goldhahn J, Simmen BR (2006) Problematic bone fixation with pyrocarbon implants in proximal interphalangeal joint replacement: short-term results. J Hand Surg Br 31(6):643–651

    CAS  Article  Google Scholar 

  17. Herren DB, Simmen BR (2000) Palmar approach in flexible implant arthroplasty of the proximal interphalangeal joint. Clin Orthop Relat Res 371:131–135

    Article  Google Scholar 

  18. Hohendorff B, Spies CK, Unglaub F, Muller LP, Ries C (2019) Anatomy of the metacarpophalangeal and proximal interphalangeal finger joint with respect to arthroplasty. Orthopade 48(5):368–377

    CAS  Article  Google Scholar 

  19. Hohendorff B, Unglaub F, Spies CK, Wegmann K, Muller LP, Ries C (2019) Surgical approaches to the hand. Oper Orthop Traumatol 31(5):372–383

    CAS  Article  Google Scholar 

  20. International Organization for Standardization (2011) ISO 14155:2011: Clinical investigation of medical devices for human subjects—good clinical practice.

  21. Jennings CD, Livingstone DP (2015) Surface replacement arthroplasty of the proximal interphalangeal joint using the SR PIP implant: long-term results. J Hand Surg Am 40(3):469-473.e466

    Article  Google Scholar 

  22. Lans J, Notermans BJW, Germawi L, Lee H, Jupiter JB, Chen NC (2019) Factors associated with reoperation after silicone proximal interphalangeal joint arthroplasty. Hand (NY).

    Article  Google Scholar 

  23. Reissner L, Schindele S, Hensler S, Marks M, Herren DB (2014) Ten year follow-up of pyrocarbon implants for proximal interphalangeal joint replacement. J Hand Surg Eur 39(6):582–586

    CAS  Article  Google Scholar 

  24. Rizzo M (2014) Proximal interphalangeal joint arthroplasty: implants and surgical approaches. Curr Orthop Pract 25(5):415–419

    Article  Google Scholar 

  25. Schindele SF, Altwegg A, Hensler S (2017) Surface replacement of proximal interphalangeal joints using CapFlex-PIP. Oper Orthop Traumatol 29(1):86–96

    CAS  Article  Google Scholar 

  26. Schindele SF, Hensler S, Audigé L, Marks M, Herren DB (2015) A modular surface gliding implant (CapFlex-PIP) for proximal interphalangeal joint osteoarthritis: a prospective case series. J Hand Surg Am 40(2):334–340

    Article  Google Scholar 

  27. Spies CK, Langer M, Hahn P, Muller LP, Unglaub F (2018) The treatment of primary arthritis of the finger and thumb joint. Dtsch Arztebl Int 115(16):269–275

    PubMed  Google Scholar 

  28. Swanson AB (1973) Implant resection arthroplasty of the proximal interphalangeal joint. Orthop Clin North Am 4(4):1007–1029

    CAS  PubMed  Google Scholar 

  29. Takigawa S, Meletiou S, Sauerbier M, Cooney WP (2004) Long-term assessment of Swanson implant arthroplasty in the proximal interphalangeal joint of the hand. J Hand Surg Am 29(5):785–795

    Article  Google Scholar 

  30. Tang JB, Giddins G (2016) Why and how to report surgeons’ levels of expertise. J Hand Surg Eur 41(4):365–366

    Article  Google Scholar 

  31. Vitale MA, Fruth KM, Rizzo M, Moran SL, Kakar S (2015) Prosthetic arthroplasty versus arthrodesis for osteoarthritis and posttraumatic arthritis of the index finger proximal interphalangeal joint. J Hand Surg Am 40(10):1937–1948

    Article  Google Scholar 

  32. Wagner ER, Weston JT, Houdek MT, Luo TD, Moran SL, Rizzo M (2018) Medium-term outcomes with pyrocarbon proximal interphalangeal arthroplasty: a study of 170 consecutive arthroplasties. J Hand Surg Am 43(9):797–805

    Article  Google Scholar 

  33. Yamamoto M, Chung KC (2018) Implant arthroplasty: selection of exposure and implant. Hand Clin 34(2):195–205

    Article  Google Scholar 

  34. Yamamoto M, Malay S, Fujihara Y, Zhong L, Chung KC (2017) A systematic review of different implants and approaches for proximal interphalangeal joint arthroplasty. Plast Reconstr Surg 139(5):1139e–1151e

    CAS  Article  Google Scholar 

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The authors would like to thank Dr. Melissa Wilhelmi (Schulthess Klinik) for the copy-editing of this manuscript and Birgit Steiger (Schulthess Klinik) and Martina Wehrli (Schulthess Klinik) for assistance in data collection.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations



OH collected the data. MM analysed the data. OH and MM wrote the first draft of the manuscript. AS, DH and SS supervised the study. All authors were involved in developing the research question, reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Stephan Schindele.

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Conflict of interest

S. Schindele and D.B. Herren were involved in the development of the CapFlex implant and receive royalties from KLS Martin Group, Tuttlingen, Germany.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval for this data analysis study was obtained from the Cantonal Ethics Committee of Zurich, Switzerland (no. 2014-0546).

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Patients signed informed consent regarding publishing their data.

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Helder, O., Marks, M., Schweizer, A. et al. Complications after surface replacing and silicone PIP arthroplasty: an analysis of 703 implants. Arch Orthop Trauma Surg 141, 173–181 (2021).

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  • Adverse event
  • Finger middle joint
  • Implant failure
  • CapFlex arthroplasty
  • Swanson silicone implant