Joint Replacement Surgery Of The Hand (cont.)

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How are patients with hand joint abnormalities evaluated?

The diagnosis of hand joint problems typically involves evaluating symptoms, physical examination, and the x-ray appearance of the joints. Blood testing is sometimes also helpful in the assessment process. Joint replacement surgery becomes a treatment option when significant joint destruction and/or deformity are present.

What are the different surgical options?

Surgical options include

  1. cleaning of the abnormal cartilage and bone, including removal of bone spurs,
  2. fusion of the joint, and
  3. joint replacement surgery.

The optimal surgical treatment of arthritis of the hand and wrist varies from patient to patient and is based on many factors. These factors include the patient's age, hand dominance, employment, level of pain, functional goals, and underlying disease.

When is surgical cleaning of the joint the best alternative?

Surgical cleaning of the joint, or salvage procedure, is usually performed in cases of early "wear and tear" arthritis where there are painful bone spurs or, in cases of rheumatoid arthritis, where there is a large amount of inflamed tissue. Removal of bone spurs is especially helpful when the arthritis involves the joints at the ends of the fingers (distal interphalangeal or DIP joints).

What is a joint fusion? When is it the best surgical option?

Fusion of a joint involves removing the joint and surgically "fusing" the bone ends so that the two bones effectively become one solid bone. This procedure terminates all motion at that joint and thus eliminates the pain. The benefit of fusion is pain relief and the downside is elimination of motion at the fused joint, which can hinder function. This surgical option is reserved for patients with advanced arthritis.

Joint fusion is usually the best surgical option in patients who are younger and very active. Younger patients may not be candidates for joint replacement because of the increased stress demand on the joints which accompany higher activity levels. This increased stress demand can quickly wear out an artificial joint.



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