Finger Joint Replacements

Finger joint replacement surgeon Sydney

As people age, it’s common to develop arthritis in one or more fingers. This may occur due to an inflammatory condition like rheumatoid arthritis, or due to wear and tear over the years (also known as osteoarthritis). The risk of arthritis is increased in any finger joint that’s previously experienced an injury, such as a fracture.

Arthritis of the fingers can make it difficult to perform some of the tasks of daily living, like opening jars, turning doorknobs, and buttoning clothing. The pain can also have a significant impact on a person’s quality of life. To achieve greater comfort, better function, and the ability to continue to live independently, treatment of the condition in one or more of the finger joints may be beneficial.

As with many other joints, it’s now possible to replace a damaged finger joint with an artificial one. What is it like to have a finger joint replacement? What are the alternative options for treating arthritis of the fingers?

What are the joints of the fingers?

To understand joint replacement in the fingers, it’s important to consider the various joints that could be involved. Each finger has three main joints (except the thumb, which has two).

The metacarpophalangeal joint, or MCP joint, is the joint at the base of each finger, where it joins with the hand. This joint has a wider range of motion than other joints of the fingers. Not only can it bend forward and backward, but the finger can also move from side to side.

The other two joints of each finger are the interphalangeal joints. These are the joints between the phalanges, or the small bones of the finger. The proximal interphalangeal joint, or PIP, is the one closer to the hand. The distal interphalangeal joint, or DIP, is the joint towards the end of the finger.

Any of these joints can potentially experience arthritis. Osteoarthritis, or “wear and tear” arthritis, commonly affects the DIP joints, and sometimes the PIP joints. It can also affect a joint at the base of the thumb known as the CMC joint. Rheumatoid arthritis, which is caused by the immune system mistakenly attacking joint tissue, commonly affects the MCP and PIP joints, but usually doesn’t affect the DIP joints.

What are the options for treating finger joint arthritis?

For people with finger joint arthritis, there are a few possible treatment options that may be helpful. Usually, we will start with the least invasive options. These include:

Hand therapy
Oral anti-inflammatory medications
Injections of a steroid (strong anti-inflammatory medication) into the joint
Surgery, which may involve:
- Fusion of the joint
- Reconstruction of the joint by a tendon taken from the forearm
- Replacement of the joint with an artificial joint

In general, Dr. Sungaran recommends starting with the least invasive options, like hand therapy and injections. If these treatments aren’t successful at relieving symptoms and restoring comfort and function, then surgery may be considered.

Surgical fusion of a finger joint will usually relieve pain associated with arthritis. However, this procedure permanently eliminates the possibility of movement at the joint. This can have a significant impact on the hand’s function. Joint replacement or reconstruction both preserve the joint’s ability to move, which allows for better hand function after the procedure.

Joint reconstruction using a tendon taken from the forearm is an option. The tendon that’s typically used for this is considered redundant, meaning that its function is also performed by other tendons in the forearm. Because of this, there isn’t a huge impact on the arm’s function when this tendon is removed. Still, this method requires an additional incision in the forearm. Many people prefer to avoid damaging a healthy forearm in order to reconstruct a damaged finger joint.

What is finger joint replacement like?

During a finger joint replacement procedure, your surgeon accesses the affected area through an incision in your finger. It may be necessary to move or split a tendon in order to get to the finger joint. The surgeon will then remove the damaged joint, including a small amount of bone on each side. This both gets rid of the damaged tissue that’s causing pain and inflammation, and also makes room for the replacement joint.

For replacement of the MCP joint (the one where the finger meets the hand), Dr. Sungaran has chosen a replacement joint known as the Ascension PyroCarbon. This artificial joint is highly durable, because it’s made from metal and a ceramic-like material. It also offers a good range of motion.

For replacement of the PIP joint (the one near the middle of the finger), Dr. Sungaran currently prefers the CapFlex artificial joint. This replacement joint is made of metal and plastic, and offers both stability and mobility.

The replacement joint will then be placed, and the incision closed. You will have significant swelling in your hand at first, and you’ll find it difficult to move your finger very much at first. Over the course of about six weeks (a little longer for some people), as the swelling resolves, mobility should mostly return to normal.

However, it will take several months after surgery for strength to be restored to the hand. It’s important to ensure that you stay diligent about completing your prescribed hand therapy exercises throughout this period, to ensure that you recover as well as possible. Our team will refer you to a good hand therapist, so that you have expert guidance to support your recovery.

Can the distal interphalangeal (DIP) joint be replaced?

The DIP joint is the smallest one in the fingers. As of this moment, we don’t have good replacement options for the DIP joint. When one of the DIP joints is causing significant symptoms and surgery becomes necessary, the joint will generally be fused, rather than replaced. Because a joint can’t move after fusion, this does have an impact on hand function, and it’s important to weigh that impact against the pain caused by the damaged joint when you’re deciding whether this procedure is right for you.