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about the Hand & Wrist> Finger Joint Replacement
Surgery What is Finger Replacement Surgery? (“Finger Arthroplasty”) Rheumatoid arthritis is a chronic inflammatory disease that causes pain, stiffness, and swelling in the joints, usually in a symmetrical pattern. That is, if one hand has it, the other one will likely have it also. In rheumatoid arthritis, the joint lining (synovium), normally smooth and shiny, becomes inflamed, painful and swollen. The disease, which lasts over a long period of time, can cause damage to cartilage, bone, tendons and ligaments. Rheumatoid arthritis in the hands can cause deformity, especially in the finger’s knuckles, or the metacarpophalangeal joints. The metacarpophalangeal joints are the knuckles that join the fingers to the hand. Involvement of the metacarpophalangeal joints in the hand is common and may greatly affect the ability to use the fingers for daily activities. In many instances, the deformities of the rheumatoid metacarpophalangeal joints will be so advanced that efforts at improving the hand by soft tissue procedures will be not be possible. In those cases, replacement of the destroyed joints may be the most practical means of relieving pain, realigning the fingers and improving function. These surgical procedures – known as arthroplasties, require the use of flexible, artificial implants. Reasons for Finger Replacement Surgery? The bones of the forearm – the radius and ulna – join the wrist with its eight small bones. The wrist bones then join the metacarpal bones which connect to the phalangeal bones of the thumb and fingers. The joints formed by the metacarpals and the first phalanges of the fingers are known as the metacarpophalangeal joints, the largest of the finger joints. The metacarpophalangeal joints are surrounded by the flexor tendons that bend the fingers toward the palm and by the extensor tendons which straighten the fingers. The metacarpophalangeal joints also have structures known as ligaments on each side for support and a firm plate on the palm side which prevents the joints from extending too far. The surface of the joint is covered by cartilage which provides the gliding surface needed for smooth motion. Movement of the muscles of the forearm and hand will cause the tendons around the joint to bend and straighten the fingers and the ligaments will keep the fingers stable. Rheumatoid arthritis affects the tendons and joints of the wrist and hand. The normal supporting tendon, ligament and capsule structures become inflamed, weakened, stretched out, and sometimes ruptured. Deformities of the wrist and fingers frequently follow the loss of joint support and combinations of wrist displacement, small muscle tightness, loss of tendon alignment, and ligament stretching can lead to severe deformities of the metacarpophalangeal joints. Depending on the severity of the disease, the joints may become quite swollen and painful. As the disease progresses the tendons that straighten the finger – the extensor tendons – may lose their centralizing fibers and slide sideways toward the little finger. Other factors may combine with the displaced extensor tendons to pull the fingers down toward the palm and sideways toward the little fingers. This combination is very characteristic of advanced rheumatoid arthritis. Surgical Procedure for Finger Replacement? Surgery for the reconstruction of the deformed rheumatoid metacarpophalangeal joints is almost always carried out on an in-patient – in-hospital basis. The surgery is performed using regional or general anesthesia and the procedures may take two to five hours depending on the degree of difficulty and any other procedures that may be carried out during the same operation. The surgeon will select the incisions of his or her preference and may use a transverse incision across all the metacarpals or longitudinal incisions to approach the joints. Special instruments will be used to remove the destroyed bone and joint. Diseased rheumatoid tissue will also be removed and other procedures may be required to eliminate deforming forces. Special instruments will then be used to prepare channels in the middle of the metacarpals and in the proximal phalanx for the stems of the implants. Trial implants will be placed in each joint space to confirm the appropriate positioning and size. The new metacarpophalangeal implants will then be seated in each joint. Small sutures will be used to close the wounds and a large bulky dressing will be applied to the forearm, wrist, hand and fingers. Rehabilitation For Finger Replacement Surgery? Patients are usually hospitalized for several days following metacarpophalangeal joint surgery in order to minimize postoperative discomfort. Suture removal – usually around two weeks -and therapy are usually carried out on an out patient basis. After joint replacement surgery, a therapy program will be designed to allow good up and down motion of the new joints while limiting side to side instability - so that the fingers will deviate much less than before surgery. Patients undergoing these reconstructive procedures must be prepared for some specialized splinting and a rather long therapy course in order to achieve the best possible result. For many patients the therapy following rheumatoid metacarpophalangeal joint reconstruction seems long and difficult. It is, however, very important that the advice and directions of the physician and therapist be closely followed if the best possible result is to be achieved. Above all, patients undergoing this type of procedure must appreciate that it cannot return a normal hand. The extent of tissue and joint destruction which rheumatoid arthritis causes cannot be completely overcome by any operation and the goal of surgery is to improve the status of the hand and slow down the destructive process. Over the next few weeks after surgery, you will have your stitches taken out and receive daytime and nighttime splints. After about three months, you will be able to use your hand for light activities without any splints, although you should still wear a light protective splint at night. Possible Complications of Finger Replacement Surgery? As with other major procedures of the wrist and hand, there can be unforeseen complications of surgery to replace the diseased metacarpophalangeal joints in rheumatoid arthritis. Rarely, anesthesia problems including pulmonary, cardiac, neurological, or vascular malfunction could complicate surgery and even be life threatening. Postoperative partial lung collapse or kidney dysfunction may also be infrequent occurrences after these procedures. Incision separation or wound breakdown is more common in rheumatoid arthritic patients than in patients without rheumatoid disease and must be dealt with by careful wound care. Infections can also complicate the recovery process, particularly if the infection involves the small joint implants. Very rarely the new joints actually have to be removed to deal with the infection. On rare occasions the implants may dislocate during the postoperative therapy and surgical relocation may be necessary. Flare-ups or worsening of the disease may be experienced by a few patients. Finger joint stiffness can occasionally be more than expected and will require more aggressive therapy. Late problems after metacarpophalangeal replacement surgery include bending or fracturing of the implants which may lead to the return of finger deformities. Joint revision and implant replacement may be required for those patients. Even after the best surgery and therapy, there may be a gradual return of some sideways displacement of the fingers in some patients. However, surgical reconstruction of the metacarpophalangeal joints using high quality silicone rubber implants, appropriate soft tissue repair techniques, and a good therapy program can substantially improve the alignment and function of the joints. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |