Finger Joint Replacements

Joint Replacement for the Fingers

By Christopher M. Brian, MD

Replacement of the metacarpo-phalangeal joints (the “knuckle” joint) and the proximal interphalangeal joints of the fingers have been around since the 1960’s.  The Swanson Hinged Silastic Spacer (also known as “rubber knuckles”) has enjoyed a particularly high success rate for patients with rheumatoid arthritis in whom 90% 10-year survivorship has been reported.  In the last few decades, there has been resurgence into the development of “metal” implants that have anatomically designed articular components that match the shape and geometry of the native joint.  By design, only a minimal amount of the arthritic joint is removed and the surrounding soft tissues are preserved to support the components.

The most common patients needing replacement of the finger joints are patients with rheumatoid arthritis.  In addition, patients with degenerative arthritis or post traumatic arthritis are eligible for joint replacement arthroplasties.  Typically, your surgeon will perform a physical exam and order radiographs to evaluate the extent of damage to the finger joints and supporting soft tissues.  Non-surgical treatment for arthritic finger joints include: medications (such as aspirin), avoiding heavy lifting or use of the hand and fingers, steroid injections into the joint, and physical therapy exercises and splints.

If you and your surgeon decide that an implant arthroplasty is best to treat your condition, there are two general types of implants commonly used today.  The silastic implant is a one-piece component that requires additional balancing soft tissue procedures at the time of surgery to support the implant and prevent recurrent deformity from occurring after the surgery.  The other type of implant is a two-piece joint implant that is designed to replace each side of the joint.  It requires the surrounding collateral ligaments to be intact and functioning in order to work. The benefits of replacing arthritic finger joints include pain relief, improvement in finger motion, and improvement in the appearance or cosmetic look of the fingers and hand.  However, finger surgery may also cause some problems.  These problems do not usually happen, but it is best to know the risks.  Be sure and ask your surgeon what these risks are.

When non-operative measures are no longer effective, and the benefits outweigh the risks, then you may choose to proceed with the surgery.  Typically, the surgery will last for a few hours and is usually done on an outpatient basis.  The rehabilitation is extensive and requires an active participation by the patient.  Typically, the fingers are immobilized for the first week or two after surgery.  Next, custom dynamic splints as well as static splints are made by a certified hand therapist to allow for protected range of finger motion while the surrounding tissues are healing.  Rehabilitation therapy may last up to 3 months after surgery. If you are considering such a surgery, it is important to know that your surgeon has specific training that requires certification for this technique.  As with any surgery, it is important to ask as many questions of your surgeon as you need to in order to be comfortable with your decision.