Finger joint replacement can ease pain and stiffness, surgeon says

Recovery from finger joint replacement surgery can be faster and less painful than larger joint replacement.

The tiniest joints of the fingers can break down over time and, in some people, need to be replaced. The wear and tear can cause unbearable pain and stiffness. Dr. Ryan M. Zimmerman, a hand, shoulder and elbow surgeon at the Curtis National Hand Center at MedStar Union Memorial Hospital, said replacement can provide much-needed relief for patients.

What causes finger joints to wear out?

Finger joints can wear out for a number of reasons. Osteoarthritis, which is primary wear and tear, is the most common. Inflammatory conditions, such as rheumatoid arthritis, are also common. Finally, after trauma, joints can have residual irregularities that cause them to wear out more rapidly. Contrary to popular belief, repetitive activities such as typing have not been linked to arthritis.

Can all joints in the hand be replaced?

Many joints in the hand are candidates for joint replacement, but others are best treated with different kinds of surgery. The metacarpophalangeal joints, what people think of as their "knuckles," that connect the finger to the palm and the joints just past those, are the best candidates for replacement. The joint at the base of the thumb, by far the most common place for people to develop arthritis, is best treated with a different kind of joint replacement surgery for patients who don't get adequate relief from splints or injections. Also, the joints at the fingertips are best treated with a different type of surgery because they are too small for formal replacements.

Who is a good candidate for finger joint replacement, and how do you know that someone needs such a procedure?

A good candidate for finger joint replacement is somebody whose pain and stiffness bothers them enough to consider surgery, has strong enough bone and is willing to do some therapy after surgery to ensure they get the best result possible. A surgeon can determine whether somebody is a good candidate by understanding their symptoms, performing an exam and ordering X-rays to make sure that the bone is strong enough. Heavy lifting and forceful use after finger joint replacement can make the replacement wear out faster, so very young patients or those who do a lot of lifting may want to delay surgery as long as they can. Ultimately, the decision about if and when to proceed is up to the patient.

Are there certain conditions or occupations where people are more likely to need finger joint replacements?

Inflammatory conditions such as rheumatoid arthritis make patients more likely to need finger joint replacements. Occupations or activities that rely on repetitive hand motions can make people notice their symptoms more because they pay more attention to their hands, but as far as we know, activities and occupations do not cause people to need finger joint replacements.

How does the procedure and recovery differ from replacing larger joints?

The smaller size of hand joints does introduce some unique challenges, such as carefully positioning the implants in small bones and delicately balancing the ligaments that keep the bones stable. Recovery is different from larger joint replacements. First of all, patients go home the same day, and blood loss is minimal. Also, the risk of complications like blood clots or heart or lung problems is much lower. Recovery from any joint replacement surgery takes some time and effort, but the recovery after finger joint replacement tends to be faster, less painful and the therapy easier than for a larger joint.

Do all the joints usually wear out at the same time, or is usually a joint on just one finger?

In patients with inflammatory conditions like rheumatoid arthritis, multiple joints often wear out at once and are often replaced during the same surgery. Patient with osteoarthritis or arthritis that started from trauma typically have just a single joint that wears out.

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