Chapter 26 Arthroplasty of the Proximal Interphalangeal Joint
ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN ARTHROPLASTY OF THE PROXIMAL INTERPHALANGEAL (PIP) JOINT
If you choose a dorsal approach, you can see that you have repaired the extensor mechanism properly to get the best possible active extension without rupture of the repair. You watch the patient take the finger through a comfortable pain-free range of motion before skin closure. Sometimes the closing sutures in the extensor tendon will burst with intraoperative testing of full flexion and extension of the PIP joint. It is better to know that and fix it before you close the skin so that a boutonniere deformity does not develop later.
Patients get to see that their previously stiff joint now moves as they watch themselves flexing their finger before the skin is closed. They realize that their hand will work well once they get past the postoperative discomfort and stiffness.
Through intraoperative teaching and patients’ ability to observe the repair, they will have a realistic expectation of the best possible outcome of range of movement when they leave the operating room.
You are sure that the motion is optimal before closing the wound. You can adjust the tissues around the implant based on what you see with active movement.
All of the general advantages listed in Chapter 2 apply to both the surgeon and the patient.
WHERE TO INJECT THE LOCAL ANESTHETIC FOR PIP JOINT ARTHROPLASTY
See Chapter 1, Atlas, for more illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.