Joint Replacement - Fingers

Among the joints of the upper body, degenerative osteoarthritis (OA) most frequently affects the fingers. The most common form of arthritis in the United States, OA in the hand is diagnosed in nearly 90 percent of women and 80 percent of men between the ages of 75 and 79. Rheumatoid arthritis also most commonly affects the finger joints.

Severe forms of finger joint deterioration can cause deformity and debilitating pain. When deteriorating joints of one or more fingers become nonresponsive to other treatment options and pain and limited function hinder a patient's quality of life, a finger joint replacement may be indicated. A finger joint replacement eliminates pain and restores strength and function to the finger and hand by replacing the damaged joint(s) with an artificial one.

About the Finger Joints
The finger joints work as hinges when the fingers straighten out and bend. The different finger joints include: the metacarpophalangeal joint or MCP joint, which is the knuckle joint; and the interphalangeal joints or IP joints, which are the joints connecting the tip, middle and base of the phalanges in each finger.

The IP joint closest to the knuckle is the proximal IP joint or PIP joint and the joint closest to the tip of the finger is the distal IP joint or DIP joint. The joints are held together by touch bands of ligaments, the strongest of which is the volar plate located within the PIP joint. Those joints most often affected by degenerative conditions are the MCP and PIP joints.

A finger joint replacement procedure is named according to the type of finger joint to be replaced - MCP, PIP or DIP.

The Procedure

Once the decision is made to proceed with joint replacement, a series of tests and imaging scans are performed in order to ensure the best possible outcome. The procedure is performed as either an in-patient or out-patient procedure, depending on the condition of the patient, number of joints affected and anticipated length of the procedure.

Once the patient is prepared for surgery and anesthesia is administered (either general anesthesia or local anesthesia depending on patient conditions), the procedure begins.

An incision is made on the back of the hand or finger in order to expose the joint. The incision in a PIP joint replacement may be made on the palm side of the affected hand.

Portions of the damaged joint are then removed, along with any bony spurs often associated with arthritis. Small canals in the middle of both phalanges that comprise the finger joint are prepared and readied for the implant stems. After the joint space and opposing bone canals are prepared the patient is fit with a replacement joint that fits their particular joint space. The fit of the implant is assessed and finger movement is tested. The wound is then closed and a large dressing is placed around the fingers, hand and wrist.

The hand is kept elevated following the procedure in order to prevent swelling and subsequent stiffness that can result from swelling. Pain medication and possibly antibiotics are prescribed. Once the dressings are removed several days following surgery, a lighter dressing is placed around the fingers and rehabilitation is discussed.

Rehabilitation is a key component to a successful recovery and resumption of normal activity.