Athroplasty

1 What is an Arthroplasty (Joint Replacement Surgery of The Hand)?

Arthroplasty is the joint replacement surgery of the hand.

Arthritis of the hand and wrist is a very common and complex problem with many non-surgical and surgical treatment options.

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The most common symptoms of arthritis of the hands include pain, stiffness, and swelling in the joints. The pain is usually worsened when the joint is moved. Moreover, the motion of the joint is frequently limited due to pain and joint contractures.

Symptoms can lead to difficulty with daily living activities including tying shoes, buttoning buttons, opening jars, or turning a key in a lock.

The primary doctor, the arthritis specialist (rheumatologist), and/or an orthopedic surgeon decide which alternative is best for the patients. Surgical options for treatment of arthritis of the hand include cleaning of the abnormal cartilage and bone, fusion, and replacement surgery.

Joint replacement surgery involves replacing a destroyed joint with an artificial joint. This procedure is typically employed in treating severe arthritis involving certain joints.

In knee or hip replacement surgery, the artificial joint is made out of metal and plastic but in the case of joint replacement in the hand the new joint is most commonly composed of silicone rubber and has 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 most frequently used silicone joint implants are termed the Swanson implant and the Sutter implant.

Surgical options for the hand joint replacement differ according to the specific joint(s) involved:

  • DIP joint (joint closest to the fingertip). It is not a good candidate for joint replacement because the bones are very small and do not hold the implant very well. The best treatment option is fusion.
  • PIP joint (second joint from the fingertip). The small and ring fingers are the best candidates for joint replacement. 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 so these forces cause excess stress on the joint implant and can lead to early implant breakage.
  • MCP joint (third joint from the fingertip). It is rarely affected by osteoarthritis but the mostly affected by rheumatoid arthritis.
  • Thumb basal joint (where the thumb meets the wrist). It is exposed to very high stresses with normal activities but attempts at silicone replacement of this joint have not been as successful as hoped due to implant failure and bone destruction. The most common joint replacement procedure for the thumb base is done with natural material and the procedure is termed the ligament reconstruction tendon interposition procedure (LRTI) because this procedure uses the patient's own tendon to stabilize the thumb and resurface the joint. LRTI provides stability and pain relief and long-term results have been excellent.
  • Wrist joint. Most patients with wrist arthritis are best treated with surgical joint cleaning or fusion and not a joint replacement because most wrist-joint prostheses on the market are currently investigational and for use in extremely low activity patients with osteoarthritis or rheumatoid arthritis.

After any type of joint reconstruction surgery, there is a period of recovery. The patient may need to use a postoperative splint or cast for awhile after surgery that helps protect the hand while it heals. Often, the patient will be referred to a trained hand therapist, who can help maximize recovery. However, patients can usually return to most if not all of their desired activities in about three months after most major joint reconstructions.

Often, the patient will be referred to a trained hand therapist, who can help maximize recovery. However, patients can usually return to most if not all of their desired activities in about three months after most major joint reconstructions.

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