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Overview

Hand joint replacement surgery is most commonly recommended to patients with severe arthritis facing severe pain or swelling in the hand joint. Hand joint replacement is a less common type of surgery. Joint fusion is an alternative for Hand joint replacement. For a joint fusion, the joint is removed and the bone ends are fused together so that the two bones become one solid bone. Joint fusion is very effective in managing the pain in the joint but it eliminates the motion of the fused joint. Young patients, with higher physical activity, may be recommended a joint fusion because of the stress demand on the joint. The high stress demand on the joint can be a reason of rapid wearing out of the artificial joints. However, Hand joint replacement is always a better option for those who desire an improvement in the functioning of hand. Another method employed to fight hand joint pain is surgical cleaning or salvage procedure. This method is generally used in cases of early wear and tear, and in cases of rheumatoid arthritis where there is a large amount of inflamed tissues. Surgical cleaning is helpful when the joints at the end of fingers are affected by arthritis.

 

The Hand and its Joints

The hand is made up of many different bones. The base of the hand has two rows of carpal bones, which, along with the radius and ulna, form the wrist joint. Other than carpal, hand has several bones in the fingers and thumb. A joint is formed whenever two or more bones meet.
Each finger has three joint:
  • Metacarpophalangeal joint (MCP) – the joint at the base of the finger
  • Proximal interphalangeal joint (PIP) –  the joint in the middle of the finger
  • Distal interphalangeal joint (DIP)  – the joint closest to the fingertip
Each thumb has two joints. The ends of the bones, where they meet to form a joint, are covered with a layer of articular cartilage which allow smooth movement of the bones. The joint is enclosed with a thin membrane called synovium, which secretes a fluid called synovium fluid that lubricates the joint.

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Hand Joint Replacement Surgery

Hand joint replacement surgery is also known as hand joint anthroplasty. This surgery is typically advised to patients suffering from acute arthritis or those having a severe fracture of the hand joint. In hand joint replacement, the painful or damaged joint is surgically replaced by an artificial joint. Implants, for most of the joint replacement, are made up of metal or plastic. However, for Hand joint replacement, a new type of joint is commonly used. This joint is made of either silicone rubber or patients own tissues such as the tendons.

Causes

The major reasons that account for hand joint replacement are osteoarthritis, rheumatoid arthritis and fractures. Osteoarthritis is an age driven arthritis that lead to wearing out of articular cartilage which in turn damages the joint bones and cause severe pain. In rheumatoid arthritis, the membrane surrounding the joint gets inflamed. The third condition that lead a patient towards hand joint replacement surgery is, a severe fracture of the hand joints.

Surgical Options According to Different Joints of the Hand

There are different types of hand joint surgeries according to different joints that are involved. The type of surgery recommended for a particular joint depends on its size, positioning and the level of stress it has to bear.

  • DIP joint (joint closest to the fingertip): Joint replacement is generally not recommended for this joint as the bones in this joint are very small and thus do not hold the implant well. Joint fusion is normally advised for this joint.

 

  • PIP joint (second joint from the fingertip): This joint is most common for joint replacement. Hand function, like grasping, can be hindered by fusion of this joint. However, index finger is not good for joint replacement as it has to bear excessive stress which may lead to early wearing out of the implants. Small and ring fingers are best suited for replacement surgery.
    Many types of artificial joints are designed for PIP joint replacement, but only silicone interpositional anthroplasty has proven to be successful. These type of implants use silicone rubber with a flexible hinge in the middle. Stems of the implant are inserted into the bones to provide stability.

 

  • MCP joint (third joint from the fingertip): This joint is very well suited for joint replacement. Most commonly used type of replacement, having excellent long term results, is silicone joint replacement.

 

  • Thumb base joint: This joint has to bear very high stress level, thus, silicone replacement is not very well suited for this joint. However, the ligament reconstruction tendon interposition procedure has proven to be very successful.

Process of Recovery

Medicines to prevent infections and to provide pain relief are given for few days after the surgery. The patient is relieved from the hospital in 2-4 days. If the patient experiences a severe pain after a few weeks of surgery, it is recommended to visit the doctor at the earliest. Exercises recommended to avoid stiffness and swelling, must be done regularly for rapid recovery.

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