Arthritis can cause significant damage to the hands, leading to deformity, pain, and disability. Still, the surgery to repair damage from hand arthritis is relatively rare.
A key reason for this is a higher complication and failure rate in finger surgery. However, for people with severe pain not relieved by conservative techniques, a surgical procedure may be worth it. The primary reason to undertake surgical procedures for hand arthritis is pain relief.
Board certified plastic surgeon Dr. Bram Kaufman provides hand surgery to patients in Cleveland, Beachwood, Pepper Pike and Lyndhurst, OH, and surrounding locations.
Fusion vs. Replacement
The two key surgical options for hand arthritis are arthrodesis (fusion) and arthroplasty (total knuckle replacement). Arthrodesis involves fusing the bones of the joint together, creating a more stable, stronger, and essentially pain-free knuckle, but one with limited movement or flexibility.
In arthroplasty, the damaged joint is removed and replaced with an artificial implant. The objective is pain relief and restoration of the shape and some movement in the hand. However, the outcomes are typically less satisfactory than with knee and hip replacements. One issue is that hinged finger implants do not fully replicate normal finger movement.
A majority are made from silicone rubber, which is pliant but breaks and slips easily. According to some studies, up to 30 percent of silicone implants fail within ten years, making it an unsuitable choice for younger patients.
The joint needing repair, the patient’s age, and activity level, and amount of stiffness that the finger – and patient – can tolerate will determine whether arthrodesis or arthroplasty is used. It is not uncommon to have both procedures undertaken on different joints in the same hand.
Here is a more detailed account of how the procedures are used for different joints.
In general, arthroplasty is always used to repair the knuckles at the base of the fingers, where movement and flexibility are important. These metacarpophalangeal joints, which are the largest in the hand, are crucial to finger function but can be seriously compromised by rheumatoid arthritis (RA).
Joint replacement ideally eliminates pain and restores some mobility. However, the results depend on the amount of healthy soft tissue an individual has.
Base of the Hand
Proximal interphalangeal (PIP) joints are the second from the base of the hand. They are prone to rigidity and significant loss of movement, typically due to osteoarthritis (OA). Sometimes replacement surgery is used to relieve these symptoms, particularly in the ring and middle fingers, which need to remain flexible to be able to grip.
However, these joints undergo heavy use. So, implants can wear out faster. Some physicians favor fusing most PIP joints as they tolerate stiffness better than joints close to the hand, and fusion is a reliable, sustainable solution.
Ends of Fingers
Arthrodesis is often used to address arthritis pain in the distal interphalangeal joint. It typically results in pain-free, stable, and a relatively functional joint. The more serious complication is the inability of the fused bones to grow together or align properly, which may necessitate further surgery. A majority of people achieve good to excellent results.
Cosmetic surgeon Dr. Bram Kaufman receives patients from Cleveland, Beachwood, Pepper Pike and Lyndhurst, OH, and nearby areas for hand surgery.
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