Joint replacement can be performed in the hand for arthritic joints that cause pain. In arthritis the joint surfaces rub together and cause pain and also deformity. This is most commonly seen in osteoarthritis or rheumatoid arthritis. There are a number of Non surgical and surgical options.

Non - Surgical treatment

Thermoplastic splints

Painkillers - e.g. NSAIDs

Steroid injection into the joint

Surgical Treatment Options

(A) Joint fusion or ‘Arthrodesis’

Fusing the joint can correct deformity and relieve pain. However the joint will be fixed and must be placed at a functional position. Fusion can be performed with wires or screws. (see picture)

(B) Joint replacement or ‘Arthroplasty’

The joint can be replaced with silicone (Swanson joint) or a Pyocarbon joint. I tend to use Silicone joint replacements, they are very effective at relieving pain and preserve some range of motion at the joint.

What does the operation involve?

The operation is usually performed under regional anaesthetic however in some scenarios it can be done under local anaesthetic. The operation involves an incision over the arthritic joint. The damaged joint is cut out and replaced with a silastic or metal joint. The tendons, ligaments and soft tissues are repaired over the joint.

At the end of the procedure the hand is placed in a cast. Patients are reviewed on day 3 by Hand therapy and are given exercises

What are the common complications?

After a silastic joint operation movement is usually half that of a healthy joint. These silastic implants do not last forever and will eventually need replacement.

Infection

Tendon rupture

Fractured implant

Bone fracture

Bone loosening - Bone around the implant absorbing

Dislocation - more common in pyocarbon implants

Synovitis - inflammation of the joint

Complex regional pain syndrome - hand becomes swollen painful and stiff after the procedure.