Finger replacement surgery for arthritis
Many types of inflammatory arthritis affect the tendons and joints of the wrist and hand. The normal supporting tendons, ligaments and capsular structures become inflamed, weakened, stretched out, and occasionally ruptured. Depending on the severity of the disease and the response to medical therapy, 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 ability 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 characteristic of advanced rheumatoid arthritis, the most common inflammatory form of arthritis. Surgery for the reconstruction of the deformed arthritic 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 inflamed joint 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. 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 long therapy course in order to achieve the best possible result. It is very important that the advice and directions of the physician and therapist be closely followed if the best possible result is to be achieved. Patients undergoing this type of procedure must be taught that the end result will not be 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, the patient will have their stitches taken out and receive daytime and nighttime splints. After about three months, they will be able to use their hand for light activities without any splints, although they should still wear a light protective splint at night. As with other major procedures of the wrist and hand, there can be complications of surgery. 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.
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