Finger joint replacement or fusion

Joint replacement

Prosthetic joint replacement surgery can be considered for a painful and stiff finger joint. This is an operation most commonly performed for advanced osteoarthritis.

Finger joint replacement requires careful planning and exacting post operative hand therapy. It is not suitable for patients who cannot attend hand-therapy appointments regularly for at least six weeks after surgery. The operation is under general anaesthetic as a day case procedure.

I have used the Ascension Pyrocarbon proximal inter-phalangeal joint replacement, and metacarpo-phalangeal joint replacement, for more than years. Pyrocarbon, is a strong ceramic like material with similar mechanical properties to bone. Joint replacement requires removal of the existing joint surfaces with a very specific geometry that allows the two parts of the pyrocarbon prosthetic joint replacement to be inserted with a tight fit: no cement or screws are used to hold the prosthesis in position.

Further information
Patients can find further information on the Ascension website:
https://www.integralife.com/file/general/1524246316.pdf

Joint fusion

For some finger joints stability is more important than mobility. I will offer some patients joint fusion. This can be done as a local anaesthetic day case procedure. The joint can be fused using either buried wires and screws or in some patients the "Carpal Fix" device: https://www.extremitymedical.com/upper-extremity/carpalfix/

The index and middle finger proximal interphalangeal joints are more likely to be suitable for fusion, where as the joints of the small and ring finger are more likely to be suitable for replacement

Results

The operation is reliable at reducing pain, the range of movement after surgery is less predictable: on average patients will achieve 10 degrees improvement in their active range of movement, some patients achieve more, others less. Most patients have an improvement in their pinch and power-grip strength.

To provide access to the joint surfaces the extensor tendons are split, patients almost invariably need to wear a protective splint in between exercises for about 4-6 weeks after surgery to allow this split to heal fully. A significant proportion of patients will also hear a relatively quiet squeak after finger joint replacement surgery when they bend their finger.

Risks

All joint replacements can loosen or become displaced with time. Data looking at the survival of pyrocarbon metacarpophalangeal joint replacmenst suggest that at 15 years after surgery approximately 30 % of the replacement joints will have become loose.

Joint fusions can in rare instances fail to unite within 6-8 weeks after surgery. Once union is achieved the likelihood is the the joint will be stable and largely pain free indefinately.

To make an appointment
please call 01223 550 881 or email: sam.lilley@Cam-med.co.uk

Cambridge Plastic Surgery

Finger joint replacement or fusion

Results

Risks

Cambridge Plastic Surgery