Joint Replacement Surgery Of The Hand (cont.)

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When is joint replacement surgery the best surgical option?

Joint replacement surgery in the hand is an excellent option for treating arthritis of the hand in older, low-activity patients and for those with rheumatoid arthritis. Joint replacement surgery can provide pain relief, increase finger range of motion, and improve hand function.

How do the surgical options vary with the different joints of the hands and wrists?

Hand joint replacement surgery options differ according to the specific joint(s) involved.

1. DIP joint (joint closest to the fingertip): This joint is not a good candidate for joint replacement. The bones are very small and do not hold the implant very well. The best treatment option for advanced arthritis at this joint is fusion. Hand function is only minimally compromised by lack of motion at this joint after a fusion procedure, while pain is relieved.

2. PIP joint (second joint from the fingertip): Joint replacement is commonly performed in the PIP joint. Hand function, especially power grasp, can be hindered by fusion of this joint. The small and ring fingers are the best candidates for joint replacement as they are the most important for power grasp. The index finger is not a good candidate for a PIP joint replacement, as it must withstand sideways forces which accompany movements such as key turning and fine manipulation of objects. These forces cause excess stress on the joint implant and can lead to early implant breakage.

There have been numerous false (prosthetic) joints designed for PIP joint replacement, but only one has stood the test of time. The only nonexperimental PIP joint replacement is the silicone interpositional arthroplasty. These joints are made of silicone rubber and have a flexible hinge in the middle and stems at the ends which insert into the shaft of the bone, providing stability. The most frequently used silicone joint implants are termed the Swanson implant and the Sutter implant.

The best results with PIP joint replacement are in patients with rheumatoid arthritis and in older, lower-activity patients.

3. MCP joint (third joint from the fingertip): Osteoarthritis rarely affects the MCP joints. The most common need for joint replacement in this joint is destruction from rheumatoid arthritis. Silicone joint replacement of the MCP joint has been used since the 1960s and has produced excellent long-term results.

4. Thumb basal joint (where the thumb meets the wrist): This joint is exposed to very high stresses with normal activities. Forces felt at the tip of the thumb are multiplied 12 times in their effect to the thumb base, thus predisposing this joint to wear. Arthritis of this joint is very common, especially in women, and frequently requires joint replacement. Attempts at silicone replacement of this joint have not been as successful as hoped due to implant failure and bone destruction. Thus, the most common joint replacement procedure for the thumb base is done with natural material. The procedure is termed the ligament reconstruction-tendon interposition procedure (LRTI). This procedure uses the patient's own tendon to stabilize the thumb and resurface the joint. LRTI provides stability and pain relief. Long-term results have been excellent. This has also been called the tendon roll or "anchovy" procedure because the tendon used is curled to form the new joint cushion.

5. Wrist joint: Most patients with wrist arthritis are best treated with surgical joint cleaning or fusion and not joint replacement. Most wrist-joint prostheses on the market are currently investigational and for use in extremely low activity patients with osteoarthritis or rheumatoid arthritis.

Summary

Arthritis of the hand and wrist is a very common and complex problem with many nonsurgical and surgical treatment options. Deciding which alternative is best can require the skills of the primary doctor, the arthritis specialist (rheumatologist), and/or an orthopedic surgeon.

Joint Replacement Surgery of the Hand At A Glance

  • Joint replacement surgery involves replacing a destroyed joint with an artificial joint.
  • This procedure is typically employed in treating severe arthritis involving certain joints.
  • Surgical options for treatment of arthritis of the hand include cleaning of the abnormal cartilage and bone, fusion, and replacement surgery.

Last Editorial Review: 5/9/2008



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