Finger Joint Replacement

Mr Mike Hayton
FRCS(Trauma and Orth) FFSEM (UK)
Consultant Orthopaedic Hand Surgeon

Finger joint replacements are most commonly performed at the proximal interphalangeal joint (PIPJ) and metacarpal interphalangeal joint (MCPJ). The PIP joint replacements are usually performed for osteoarthritis, whereas the MCP joint replacements are usually performed for rheumatoid arthritis, but also osteoarthritis. The general principles of surgery are similar for both procedures in that the arthritic ends of the bone that have had the articular cartilage destroyed are prepared to accept the new joint replacement.
The joint replacement stems are inserted into the bone canal and the surrounding bone is allowed to grow onto the implant stem to fix it in place or, in the case of a silicone implant, sit quietly next to the bone as a spacer.

There are a number of commercially available implants. The most commonly performed in rheumatoid arthritis is a small silicone (plastic) hinge, whilst newer generation implants (usually of two components) are performed for osteoarthritis. The silicone hinge is still implanted in large numbers in both osteo ad rheumatoid arthritis.

Who does it affect?

Arthritis usually occurs in people over the age of 40.

Why does it occur?

Osteoarthritis is a simple wear and tear problem. In this situation the articular cartilage which is the slippery lining of the joint is worn away. In Rheumatoid arthritis, the disease process attacks the lining of the joint and destroys the cartilage.

Symptoms

Pain, swelling and a decreased range of movement is the hallmark of finger joint arthritis.

Clinical examination

The patient may have a swollen joint that is stiff. in later stages the joint may start to angle to one side or the other dues to asymmetric wear of the articular cartilage and bone ends.

Investigations

X-rays usually confirm the diagnosis. The features of arthritis on an x-ray are loss of joint space. In a normal joint the articular cartilage cannot be seen and therefore is a space on x-ray. When the cartilage is gradually worn away this space is reduced until bone rubs on bone and the space is obliterated. Furthermore in osteoarthritis, new bone forms at the edges of the joint (osteophyte), cysts (holes) appear in the bone and the ends of the bone harden showing an increased white appearance (sclerosis).

Non-operative treatment

Corticosteroid injections in to the joint, usually under x-ray control can often give pain relief.

Operative treatment

PIP joint replacement

An incision is made, usually under local anaesthetic, on the back of the finger. The tendons are displaced to one side. The ends of the bone are removed and the medullary canal of each bone is prepared to accept the implant stem. Having inserted the implants the range of movement is assessed, as is the stability and looseness of the joint. The wounds are sutured back into place and the patient is placed in a splint. Within two to three days the patient will be seen by a Hand Therapist, and a structured rehabilitation program will take place.

Here is a training video that I prepared for surgeons in training. Please note it contains live surgery video footage.

These are images of a good result, the scar is well healed and mature. The implant has been in place for more than 12 months.

This is the straightening (extension) achieved.

And this is the flexion (bending) obtained

Click below on the video clip to see a patient who is only 10 days following a finger (PIPJ) joint replacement.

MCP joint replacement

The surgical principles are very similar in that a surgical incision is made on the back of the hand. The tendons are displaced to one side. The ends of the bone are removed and the medullary canal of each bone is prepared to accept the implant stem. Having inserted the implants the range of movement is assessed, as is the stability and looseness of the joint. The wounds are sutured back into place and the patient is placed in a splint. Within two to three days the patient will be seen by a Hand Therapist, and a structured rehabilitation programme will take place.

Here are some images of a MCPJ replacement demonstrating range of movement.