Pyrocarbon arthroplasty of the proximal interphalangeal joint (PIPJ) has been reported to provide excellent pain relief when treating osteoarthritis of the hand. We retrospectively reviewed 20 PIPJ arthroplasties performed on 14 patients by a single surgeon using Ascension prosthesis. The mean follow up period was 3.5 years (range 1-7 years). Excellent pain relief was noted at the final follows-up. The mean range of motion improved from 40° pre-operatively to 70° post-operatively which was statistically significant. Twelve patients had significant improvement in quality of life and would consider similar procedure for other fingers. Radiological assessment revealed an average of 1 mm subsidence and there was no correlation noted between subsidence, migration and ROM at the final follow-up. Stiffness was the main complication and was comparable with other studies. The results of this series are encouraging and demonstrate excellent to good outcome in 86% of patients at the mid-term follow-up.