Joint Replacements in the Hand

Chances are, you probably know someone who's had a knee or hip replacement. Every year, more than 750,000 Americans undergo one of those procedures. But, what about joint replacements in the hand?

Yes, it is possible to have those tiny joints in your fingers and hands replaced with prostheses (a procedure known as arthroplasty) in order to ease the pain and suffering associated with arthritis. Although this type of surgery is less common for knuckles than for knees or hips, it can provide rapid relief for ailing hands.

The hips and knees are more commonly affected by the wearing of cartilage (degenerative arthritis), because of continuous stress from walking, running, sporting activity, or injury. However, the joints of the hand also experience stress in everyday use. Because hand joints are smaller, these stresses are concentrated over a smaller surface area. This high ratio of stress to surface area can cause the cartilage to degenerate, leaving the underlying bone exposed. When the deteriorated joint moves, bone rubs against bone, which causes pain, swelling, limiting motion, and frequently a grinding or popping sensation. Furthermore, forms of arthritis that are caused by inflammation of the tissues lining the joint frequently affect the small joints of the hands and wrists to cause joint destruction. Examples include rheumatoid arthritis and psoriatic arthritis.

Who is a candidate for hand joint replacement?

To determine if someone is a candidate for hand joint replacement, your physician will evaluate symptoms, do a physical examination, and examine the x-ray appearance of the joints. Blood testing is also sometimes helpful in the assessment process. Joint replacement surgery becomes a treatment option when significant joint destruction and/or deformity are present.

What are the various surgical options?

There are multiple surgery options, including:

1. Cleaning of the abnormal cartilage and bone, including removal of bone spurs

2. Fusion of the joint

3. Joint replacement surgery

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

Surgical cleaning of the joint

Surgical cleaning of the joint, also called "salvage procedure," is usually performed in cases of early "wear and tear" arthritis where there are painful bone spurs. It may also be performed 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).

Joint fusion

Joint fusion involves removing the joint and surgically "fusing" the bone ends, effectively turning two bones into one solid bone. This procedure terminates all motion at that joint, thus eliminating the pain. The benefit of fusion is pain relief. However, 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 higher activity levels and the increased stress demand on the joints. This increased demand can quickly wear out an artificial joint.

Joint replacement surgery

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

Arthritis of the hand and wrist is a very common and complex problem with many nonsurgical and surgical treatment options. To determine which option is best for you, contact Dr. Sagini's office at (239) 337-2003.