XIAFLEX Before and After This patient had previous surgery five years ago to the middle (PIP) joint and his photos of the surgery are seen in the adjacent photo with the sutures in place. The surgery was successful at keeping his middle joint straight, however his disease progressed and now his first joint (MCP) was contracting in an area that had not had surgery. The photos on the right show successful release of the first joint. The previous surgery scars can be seen in the photos on the right.