Prosthetic arthroplasty of the PIP joint has been generally limited to silicone devices for nearly forty years. While silicone PIP arthroplasty can be successful in the ulnar digits it is generally not performed in the index finger because of inability to withstand pinch forces. A cemented and noncemented polyethylene, metal and a pyrocarbon prosthesis have been developed to allow total joint replacement at the PIP joint. The devices may be used in all fingers and commonly provide 70 degrees or more of postoperative motion. The surgical technique and clinical result examples of each of these devices will be presented.