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Small joint of Hand Replacement

Like other joints in our body, the joints in the finger may also suffer from arthritis. If non-surgical treatment methods are not easing the pain, the doctor may suggest small joint replacement that replaces the surface of the finger’s joint.

The Procedure

There are mainly two types of replacement surgeries for arthritic fingers:

• Arthrodesis: which fuses the joint
• Arthroplasty: which replaces the joint

Usually, it is a day case surgery which can be done using local anesthesia. The surgeon removes the damaged joint by making a small incision and inserts the artificial joint. Alternatively, for the fusion, the surgeon sets the joint in a fixed position and no further movement is possible. Both types of surgeries reliably remove the pain from arthritis, but the results are different regarding the freedom of movement.

Types of Finger and Wrist Joint Replacements

There are different types of prosthesis that are designed depending on the joint involved, the type of surgery and the type of arthritis. Some of them are made of silicone and some are surgical plastic and metal.

The following are some of the finger joint replacement implants that are available for all finger joints:

• 1^st Carpometacarpal Joint
• Metacarpophalangeal Joint
• Proximal Interphalangeal Joint
• Distal Interphalangeal Joint

For the wrist replacement the implant modules include:

• Hemi-wrist Implant
• Total wrist Implant

Conditions Treated

Small joint replacement is mainly used to treat Osteoarthritis (degenerative arthritis) which most commonly affects the small joints of the fingers and the base of the thumb. There are mainly two types of osteoarthritis that affects the hand;

• Primarily generalized osteoarthritis, which causes the joint to become swollen, painful and stiff. This leads to enlargement of joint and interferes the normal hand function.
• Erosive osteoarthritis is an inflammatory form of osteoarthritis, which affects the Interphalangeal joints of the hand.

Pros and Cons of Small Joint Replacement

Pros:

• Less Pain
• Better recovery
• Outpatient Surgery: the patient does not require an overnight hospital stay
• Fewer Transfusions: Because of the better surgical procedure, the patients are less likely to need blood transfusions.
• Lower infection risk: Spending less time in the hospital decreases the risk of infection in the surgery site.
• Physical therapy: a faster and more aggressive physical therapy which helps you to regain the function of the joint.

Cons:

• Stiffness: which is one of the common complication in small joint replacement
• Swelling: The finger may remain swollen for 3 months or more.
• Pain: It usually settles over first week and is usually moderate.
• Dislocation: This is a short term risk which happens before the tissue tightens. If this happens a short anesthetic is needed to relocate the join.
• Nerve Injury: A localized numbness may occur around the wound, this usually resolves with time.
• Loosening: It is a long-term inevitable complication, once it happens the joint becomes painful and swollen again. At this stage, the surgeon will convert the replacement into fusion.

Authored By: Dr. S. V. Santpure