Joint Replacement in Hands, Wrists and Elbows

What is Joint Replacement?

Joint replacement is a procedure that involves replacing a joint with an artificial joint made of a metal such as titanium in the wrist and elbow or the fingers using silicone or a metallic pyrocarbon implant, or removing the joint and replacing with a tendon from your own body such as with basilar thumb arthritis.

Healthy hands are important for performing everyday tasks, from simple activities like eating and writing to more complex tasks like typing and playing musical instruments. However, joint problems like arthritis, injuries, and degenerative conditions can pose challenges and cause pain, stiffness, and reduced mobility.

If you’re suffering from severe joint problems, joint replacement procedures can be a game-changer. These surgeries can relieve pain, restore function, and improve mobility, allowing you to reclaim your independence and enjoy a better quality of life. In this article, we explore joint replacement surgery, including when it’s necessary, the different procedures, and benefits to help you decide if it’s right for you.

When Is Joint Replacement Necessary?

Any condition that can lead to joint destruction such as common degenerative joint disease or osteoarthritis or less common trauma, rheumatoid arthritis, etc. will ultimately lead to pain, stiffness and deformity. The track record for small joint replacement is not nearly as beneficial long term as with larger joint replacements in the hip and knee due to loosening or breakage. Nevertheless in a patient with severe arthritis at certain joints such as the MCP and PIP joint of the fingers of the hand and patients with involvement of both wrists a joint replacement is usually preferred over a joint fusion or arthrodesis. In many cases a joint replacement if it fails can be converted into a fusion as a last resort.  In single wrist arthritis usually from trauma a partial arthrodesis fusing only part of the bones preserves part of the wrist movement in favor over a total arthrodesis of the wrist which is uncommon. In the elbow neither a replacement or joint arthrodesis should be performed if possible as the replacement usually doesn’t hold up to the demands of an active individual and an arthrodesis significantly limits function. Elbow arthrscopy may buy some time in making this decision.

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Various conditions and injuries can cause significant pain, stiffness, and limited range of motion. Here are some common reasons you may consider joint replacement surgery:

Arthritis

Arthritis is one of the most common reasons for joint replacement surgery in the hands. Different types of arthritis can affect the hand joints, including:

• Osteoarthritis:This degenerative joint disease occurs when the cartilage that cushions the ends of the bones wears down. It often affects the base of the thumb, knuckles, and the joints at the ends of the fingers. Osteoarthritis can cause severe pain, swelling, and reduced range of motion, making it difficult to hold objects or perform fine motor tasks.
• Rheumatoid Arthritis:An autoimmune disorder that causes the body’s immune system to attack its tissues, rheumatoid arthritis can lead to severe inflammation of the joints. This can cause pain, swelling, stiffness, and eventually deformity. The condition often affects multiple joints symmetrically and can severely limit the function of your hand.
• Psoriatic Arthritis:Associated with psoriasis, this type of arthritis can cause joint pain, swelling, and stiffness, particularly in the fingers. It can also lead to deformities and reduced mobility, making it challenging to perform everyday activities.

Trauma

Injuries such as fractures, dislocations, and ligament tears can damage the joints in the hands. Severe trauma can lead to post-traumatic arthritis, where the joint surface becomes damaged and cartilage wears away. These injuries can cause chronic pain, instability, and loss of function. Joint replacement is necessary to restore normal hand movement and relieve discomfort.

Congenital Deformities

Some people are born with congenital deformities that affect the structure and function of their hand joints. Conditions like syndactyly (webbed fingers) or underdeveloped bones can affect the joints. While some deformities can be corrected with less invasive procedures, severe cases might require joint replacement to improve the functionality and appearance of the hand.

Types of Joint Replacement Procedures

Here are some of the joint replacement procedures available:

Total Joint Replacement (Arthroplasty)

Total joint replacement involves removing the damaged joint and replacing it with artificial components. This procedure is often used for those with severe arthritis or significant joint damage and can work on several hand joints, including the wrist, the base of the thumb (carpometacarpal joint), and the knuckles (metacarpophalangeal joints).

During the procedure, the surgeon will make a small incision over the affected joint. They will remove the damaged joint surfaces and insert an artificial joint made from metals, ceramics, or high-density plastics. Once the surgery is complete, the surgical team will close the incision and place the hand in a splint or cast.

Partial Joint Replacement

Partial joint replacement involves replacing only the damaged part of the joint while preserving the remaining healthy structures. This procedure is suitable when the damage affects one side or part of the joint. Partial replacements are less common in the hand than total replacements but can sometimes be applied to the thumb base or finger joints. The procedure is similar to the total joint replacement surgery, except the surgeon will only remove the damaged part of the joint.

Joint Fusion (Arthrodesis)

Joint fusion involves permanently joining the bones of a joint. While it limits flexibility or movement, it provides a stable and pain-free joint. Joint fusion is often used for the smaller finger joints (interphalangeal joints) and sometimes on the wrist.

MCP joint replacement of all finger on the left hand of a patient with rheumatoid arthritis compared to right side prior to replacement.

During the procedure, the surgeon will make a small incision over the affected joint. They will remove the damaged joint cartilage to prepare the bones for fusion. Then, they will fix the bones together using metal plates, screws, or pins. After closing the incision, they immobilize the limb in a cast or splint.

Benefits and Risks of Joint Replacement Surgery

The potential benefits of joint replacement surgery include:

• Reduced pain.
• Improved mobility
• Better quality of life.

Potential complications associated with the procedure include infection, nerve damage, and implant failure. It’s important to choose an experienced and skilled surgeon with a proven track record in joint replacement surgery to minimize risks and achieve the best possible outcomes.

Who Should Perform a Joint Replacement?

Joint replacements should be performed by surgeons with knowledge of not only performing the surgery but when to perform such an aggressive reconstructive hand procedure. Dr. Knights knowledge of reconstructive hand surgery, allows him to first make sure all conservative treatment has been exhausted and then carefully assess your needs in activities of daily living, work, hobbies and sports to come up with a solution that is right for you.

The Hand and Wrist Institute: A Leading Provider

The Hand and Wrist Institute is renowned for its expertise and state-of-the-art facilities, specializing in joint replacement surgeries for the hands. Our team of highly skilled and experienced surgeons uses the latest techniques and technologies to ensure the best outcomes. With advanced surgical tools and materials, we perform minimally invasive procedures that reduce recovery time and improve functionality. Our excellent track record of successful surgeries and high patient satisfaction highlights our commitment to quality care.

Recovery and Rehabilitation

The recovery process involves several stages over a few months. After the surgery, you may stay in the hospital for a day or two to manage post-operative pain and gradually restore movement to the joint. You will have your hand in a split or cast to protect the joint as it heals. During the first two to six weeks, physical therapy will begin.

After six to 12 weeks, you can increase activity and physical therapy to build strength and flexibility, with regular follow-ups to monitor progress. After three to six months, most patients can resume normal activities, continuing therapy as needed. It’s important to follow the surgeon’s instructions, including medication, proper wound care, and attending all follow-up appointments to ensure optimal healing and long-term success.

Take the First Step Toward a Pain-Free Life

Take the first step towards regaining independence and improving your quality of life. At The Hand and Wrist Institute, we’re dedicated to providing personalized care and tailored treatment plans to help you achieve optimal hand function and mobility. Don’t let joint pain or stiffness hold you back. Schedule a consultation with our highly skilled surgeons today and take the first step towards a pain-free, more active future. Visit our website or fill out our online form to schedule an appointment.

Testimonials

“Due to arthritis, I found myself in the position of requiring an artificial joint replacement in my index finger. While the surgery appeared to go well, my finger eventually became stiff and unusable. My original surgeon had moved and other doctors I consulted wanted to fuse the finger. This was unacceptable so I did my research into hand surgeons and determined Dr Knight was my best hope.

During my first visit to Dr Knight, I was impressed with his knowledge and his optimism. He felt strongly that he could help me regain the use of my finger and we set up the surgery. The surgery was a complete success and his skill was readily apparent. I had very little swelling, little pain and the surgery scar was almost non-existent. I now have almost full range of movement in my finger. I could not be more pleased with my experience with Dr. Knight and his staff. Dr. Knight is a very skilled surgeon and I would recommend him to anyone requiring treatment of the hand or wrist.”

Merilee Hyman
Arthritis Patient

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Disclaimer
HandAndWristInstitute.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.