The most common types of arthritis to occur in the hands are osteoarthritis and rheumatoid arthritis. Osteoarthritis typically occurs in the knuckle joints in the finger. Rheumatoid arthritis is most common at the knuckle at the base of the finger where it joins the hand. The typical symptoms of arthritis include pain, swelling, and loss of mobility. As arthritis progresses, deformities of the finger become common, and a crooked finger is typical.
Treatment of finger arthritis is usually focused on trying to manage symptoms with simple steps. Because we don't walk on our hands, unlike hips and knees, many people can manage their symptoms with simple treatments. These conservative treatments for finger arthritis may include:hip and knee replacements, a finger joint replacement involves removal of the damaged joint surface, and replacement with an artificial implant designed to replicate normal joint function.
Finger joint replacement is intended to accomplish three specific goals. First, the replacement should relieve pain. Second, the finger joint should be stable. And finally, the finger should have good mobility. If these goals cannot be met, because of the condition of the finger, the activities of the patient, or for other reasons, then alternatives to finger joint replacement should be considered.
When Is Finger Joint Replacement an Option?Finger joint replacement should be considered when simpler treatments described above do not sufficiently relieve discomfort. Finger joint replacement is generally reserved for older patients who do not perform heavy labor activities. Because finger replacement implants may wear out or loosen over time, they are not appropriate for younger, more active patients. In these patients, alternative surgical procedures may be considered (see below).
Finger Joint Replacement SurgeryFinger joint replacement surgery is performed by first removing the damaged and deformed joint surface. Once the damaged portion of the joint is removed, the bone ends are shaped to accommodate the artificial implant. Finger implants may be made of metal, ceramic, or plastic. The implants are positioned and held tightly in the hollow center of the bone. Care is taken to protect the tendons and ligaments that surround the joint.
After surgery, you will work with a hand therapist to regain mobility and strength of the joint. Total recovery after finger joint replacement can take several months. Risks of finger joint replacement include infection, nerve injury, joint instability, and implant problems including wearing out and loosening. As stated before, generally finger joint replacements are best suited for individuals who do not stress the fingers with heavy lifting or repetitive tasks. There are other surgical procedure that are better suited to holding up to these types of activities.
Alternatives to Finger Joint ReplacementThere are other surgical options to consider if finger joint replacement is not the right option for you. Probably the most common alternative is called a joint fusion. A joint fusion is a surgical procedure to permanently remove the joint, and stimulate bone to grow where the joint once was. Often the joint is held in proper position with plates, screws, pins, or wires until the bone is fully healed. The advantage of a fusion procedure is that once healed, this is a permanent solution -- there are no implants to wear out or loosen over time. The disadvantage is that finger mobility is limited, although with many finger joints this only minimally impacts function of the finger.
Eaton C, "Finger Osteoarthritis" E-Hand.com Electronic Textbook of Hand Surgery.
Murray PM. "New-Generation Implant Arthroplasties of the Finger Joints" J Am Acad Orthop Surg September/October 2003; 11:295-301.