Small Joint Replacement Surgery in the Fingers
Small joint replacement is often performed as a result of arthritis. Symptoms that you may notice are:
- Pain in the hand and/or fingers
- Joints of the hand and fingers may be warm and tender to the touch
- Deformities such as enlarged knuckles or crooked finger(s)
There are three joints in the fingers with varying treatment needs: the DIP joint (distal interphalangeal joint), the PIP joint (proximal interphalangeal joint) and the MP joint (metacarpophalangeal joint).
The DIP joint is closest to the fingertip. It typically does not have the best results with an implant because of its small size. If a patient has severe arthritis in this joint, the best option may be to fuse the joint using a minimally invasive technique. A joint fusion eliminates pain and only slightly impairs function. Less severe cases often respond to surgical debridement, which means “to clean-up the joint” by removing bone spurs and damaged tissue and improving the healing potential of healthy tissue.
The PIP joint is closest to the knuckle. Replacement of this joint can be effective. It is most effective for the little finger and ring finger, as they are most important for grasping an object. Dr. Tyson Cobb, an orthopaedic surgeon and Director of our Hand and Upper Extremity Center, removes the damaged joint and will typically use a pyrocarbon implant to replace it, although a silicone version can also used. It ultimately depends on the patient’s condition, age, activity level, and bone quality. Postoperative recommendations typically include wearing a splint for about three weeks followed by physical therapy as needed.
The MP joint is the knuckle joint. It is sometimes damaged by arthritis. Dr. Cobb removes the arthritis and replaces it. During the operation, an appropriately fitted prosthesis is inserted between the finger bones of the joint. As a new joint replaces the damaged one, the ligament is wrapped around the joint for added protection. Dr. Cobb also uses a new technique in which cartilage is harvested from another healthier joint and transferred to the injured joint. New adult autologous stem cell techniques are also being investigated.