If you have finger pain that’s so severe that medication and hand exercises don’t provide adequate relief, joint replacement may be the next step. Until recently, the traditional surgical procedure, joint fusion, controlled the pain associated with arthritic or injured fingers but severely limited their flexibility.
Now: Specialized hand surgeons are able to replace damaged finger joints with a technique that is similar to hip-or knee-replacement surgery. Called joint replacement, or arthroplasty, the procedure not only relieves pain due to osteoarthritis and rheumatoid arthritis, but also provides enough flexibility so that you can use a tennis racket, golf club or garden tools.
What you need to know about this breakthrough procedure…
ARE YOU A CANDIDATE?
Finger-joint replacements are far less common than knee or hip replacements—in part because the intricate bone structure and miniature size of the finger joints make the procedure more challenging for surgeons to perform. But this procedure has now advanced to the point that individuals who have not received adequate relief from other medical treatments should think about having finger-joint replacement, particularly if they have an active lifestyle.
The decision to get a finger joint replaced is primarily based on one’s level of disability—how much pain you continue to experience after trying other medical treatments and the degree to which your activities are limited.
The finger joints most often replaced are the proximal interphalangeal (PIP) joint (second joint from the fingertip) and the metacarpophalangeal (MCP) joint (knuckle joint).
Any type of joint replacement is major surgery, but finger-joint replacement is relatively safe. For example, the risk for infection is relatively low—in part because the hand has an excellent blood supply, which helps prevent bacteria from entering the site of the wound. Nerves can be damaged during the procedure, which can lead to numbness and a loss of sensation, but this is a rare occurrence.
GETTING A FINGER-JOINT REPLACEMENT
If you are interested in getting a finger-joint replacement, it’s important to consult an experienced hand surgeon who performs dozens of these surgeries a year. Often, surgeons at university teaching hospitals have experience with less common procedures such as these.*
The procedure takes about an hour to perform on each joint that is being replaced. Some patients receive more than one finger-joint replacement—and, in some cases, during a single operation.
The operation does not require an inpatient hospital stay or general anesthesia. Instead, a nerve block is used to numb the arm—which allows for a quicker recovery—and patients can go home the same day.
During the procedure, the surgeon makes a small incision on the finger and removes the damaged finger joint. An artificial joint, which in many respects resembles a miniature total knee replacement, is inserted and then cemented into place.
New development: Previously, surgeons accessed damaged finger joints through the back of the hand, which delayed recovery because tendons and soft tissue were often damaged during the procedure. A less invasive approach involves accessing the finger from the palm side, which limits damage to the soft tissues and tendons.
The most commonly used material for artificial finger joints is silicone. There are no long-term studies indicating how long these artificial joints will last. However, implant fractures commonly occur after seven to 10 years.
The finger-joint replacements made of pyrolytic carbon, a type of material often used for mechanical heart valves, are the newest artificial joints available. Initially, the results were favorable when these joints were used for joint damage caused by arthritis or injury, but some recent studies have demonstrated less favorable outcomes with these prostheses, and they are still being evaluated.
Yet another option is a two-part implant coated with a cobalt chrome surface—the same materials used in many knee and hip replacements. This provides a high degree of durability and flexibility.
WHAT TO EXPECT AFTER SURGERY
Some patients begin rehabilitation one to two days after surgery, but others may need more time to heal. A removable splint is worn for four to five weeks after the procedure to keep the joint stable and help soft tissues heal and become stronger.
It is important to meet with a physical therapist twice weekly for six to eight weeks. During this time, patients learn strengthening exercises and methods to protect their new joints against excess stress. If the artificial joint loosens or gets infected, it may have to be removed and replaced with a fused joint that does not bend.
Within about eight to 10 weeks after finger-joint replacement, patients regain about two-thirds of the finger’s normal range of motion, on average. By that point, patients are able to resume their usual activities—even golf, tennis or gardening, for example. However, recovering patients continue to tape the finger with the new joint to an adjacent finger for additional support whenever they’re performing these types of activities, which require a grip and release motion.
For travelers: The devices used in finger-joint replacement are unlikely to set off scanners at airports (or in courtrooms). But just in case, most doctors provide their patients with an X-ray and/or a report indicating that they have had a finger joint replaced.
*To find a hand surgeon near you, consult the American Society for Surgery of the Hand, 312-880-1900, www.assh.org.
Source: Scott W. Wolfe, MD, director of the hand surgical fellowship program and attending orthopedic surgeon at the Hospital for Special Surgery in New York City. He is a professor of orthopedic surgery at Weill Medical College of Cornell University, also in New York City. Dr. Wolfe has published more than 100 articles in The Journal of Hand Surgery, The Journal of Bone and Joint Surgery and various other publications.