Joint replacement (arthroplasty)

Joint replacement in the hand and wrist can provide improvement in pain and occasionally in range of joint motion for patients with osteoarthritis arthritis, rheumatoid arthritis and post traumatic arthritis.

Is it suitable for me?

Joint replacement in the hand and wrist is not suitable for everyone. In many instances the soft tissue and bone changes associated with rheumatoid arthritis may make the surgery inadvisable. Joint replacement in the fingers is inadvisable if there is a lack of bone, inadequate bone configuration, poor soft tissues or chronic infection.

When joint replacement is not possible fusion of the joint may be appropriate. A joint that has been fused no longer moves, but this may be a welcome relief if it provides significant pain relief.

Choice of prosthesis

Joint replacement (implant arthroplasty) remains a challenging area of hand surgery and many questions and problems relating to it are still being studied. There are prostheses available for finger joints, the metacarpophalangeal (knuckle) joints, the trapeziometacarpal joint (at the base of the thumb), the distal ulnar head and the wrist, as well as resurfacing hemiprostheses for the scaphoid and capitate. The prostheses are predominantly made of titanium or pyrocarbon.

Some of these prostheses have not been used in large numbers and their lifespan is uncertain, so it is usual for surgeons to follow patients closely (with clinical review and X-rays) so that results can be audited and any problems that relate to a specific prosthesis are detected early. In recent years unsatisfactory follow-up results have enabled surgeons to choose a prosthesis or surgical technique that provides better outcomes. As time goes on we will continue to develop increasingly reliable techniques and prostheses, to the benefit of current and future patients.

Post operative hand therapy

Post operative hand therapy is extremely important, particularly in preventing joint stiffness. Reviews of multiple patients show that some have an increased range of movement after surgery, some have the same, and some have a reduced range of movement. Consistently performing your exercises exactly as your therapist instructs will increase the likelihood of an excellent outcome. The post operative therapy protocol lasts at least 6 weeks.

Complications

Potential complications of joint replacement in the fingers include failure to relieve pre-operative pain, failure to improve or maintain the joint range of movement (your joint may have a reduced range of movement after the surgery), injury to the extensor tendon causing inability to fully extend the joint, infection (which in severe cases may require lifelong antibiotics, removal of the prosthesis or amputation of your finger), loosening of the prosthesis requiring revisional surgery, wound healing problems, dislocation or subluxation of the joint, implant fracture, finger deformity and joint contracture.