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Joint replacements

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Finger Joint Replacements

What are they?

Finger joint replacement surgery is performed to improve the symptoms of pain in degenerate joints. The joints are most often damaged as a result of osteoarthritis (wear and tear), previous severe injury or rheumatoid arthritis. This can lead to stiffness, pain and deformity of the hands and fingers. Unfortunately, many people are unaware that these conditions are able to be corrected and live with significant pain and deformity of their hands. In much same way that both hip and knee joints can be replaced with artificial joints, so can the joints of the hand and fingers. Outcome following finger joint replacement is however slightly different. The aim of finger joint replacement surgery is to improve symptoms of pain. It is important to stress that the range of motion of the finger may not improve.

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Is it right for me?

There are a number of joint replacement options available. At your appointment your surgeon will take a thorough history of your symptoms, taking into account your general health and the demands placed on your hands. Following careful examination of your hand and fingers, X-rays will be undertaken to assess the joints carefully. All of this information will be taken into consideration when discussing which of these options will be most suitable for you. In some cases non-operative measures may be recommended (see hand arthritis) or the joint may be too damaged to consider replacement and fusion of the joint will be recommended (see finger joint fusion).

Which joints can be replaced?

The option of which implant is suitable will also depend on which finger joint is affected.

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Which joints can be replaced?

The option of which implant is suitable will also depend on which finger joint is affected.

Metacarpo-phalangeal joints (MCP):

The MCP joints are the main knuckle joints between your hand and finger. These joint are very important in making a fist. They are commonly affected by rheumatoid arthritis but also by osteoarthritis. The use of either silicone (rubber) type implants or a pyrocarbon implant will likely be discussed with you.

Proximal interphalangeal joint (PIPJ):

The PIP joints are the middle knuckle joints in the fingers. They are crucial in gripping and also in the fine control of the fingers. Options for replacement surgery here will include surface replacement (very much like a tiny knee replacement) or silicone type implants. The relative merits of each will be discussed with you at your consultation.

Distal Interphalangeal joints (DIPJ):

These are the joints that are closest to the end of your fingers. They are often affected by osteoarthritis. Joint replacements are not commonly utilised here with fusion of the joint providing excellent pain relief and stability to the end of the finger.

Is the operation undertaken as a day case?

The operation is performed under Regional and/or General Anaesthetic. You will normally be fit to go home soon after the operation, either the same day or the next day. A bulky dressing, which includes a Plaster of Paris, is applied to the hand and wrist. The arm should be kept elevated as much as possible to reduce swelling. You will be prescribed painkillers to control the pain post-operatively. The hand should be elevated as much as possible for the first 3-5 days to minimize swelling in the hand and fingers. The Plaster of Paris is worn for 5-10 days, after which a custom-made thermoplastic splint is applied by our Hand Therapist. Following joint replacement surgery patients will require extensive hand therapy rehabilitation in order to maximise the range of movement. Depending on the degree of soft tissue repair required, patients often need to be quite cautious with their initial progress in order to protect the soft tissue repairs. This will be closely supervised by the hand therapy team.

What outcome can I expect?

Finger joint replacement surgery is primarily performed to improve symptoms of pain. It can also improve the appearance and restore the alignment of the fingers. Improving the amount that the fingers bend following the surgery is less predictable. The scientific evidence supports the fact that most patients will have either the same or slightly less movement following a joint replacement, but some patients will have more. Satisfaction from the operation is often reported in relation to the dramatic improvement in symptoms of pain however. The prostheses do wear over time and on occasions patients may need to have revision surgery. This is more likely in younger patients or patients involved with heavier or repetitive use of the hands. You will be advised to protect the hands where possible with this in mind.

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