Joint Arthroplasty

• Advanced Osteoarthritis: This condition involves the breakdown of cartilage in finger, thumb, or wrist joints, leading to bone-on-bone contact that causes pain and stiffness. Joint replacement becomes an option when the cartilage loss significantly affects gripping, pinching, or fine motor skills.

• Rheumatoid Arthritis: This autoimmune disease commonly affects the small joints of the hands, causing chronic inflammation of the joint lining, resulting in cartilage and bone damage. Joint arthroplasty can help restore hand function when medication fails to control joint destruction.

• Post-traumatic Arthritis: This develops after serious injury to finger, thumb, or wrist joints. The impact damages the cartilage directly or causes joint misalignment, leading to premature wear. Reconstruction may be needed when the joint structure becomes compromised, affecting hand dexterity.

• Joint Deformity: Conditions like Dupuytren’s contracture can cause finger joint misalignment. Arthroplasty corrects structural issues that limit finger movement and hand function.

This approach involves replacing all articulating surfaces of a finger, thumb, or wrist joint with artificial components. The procedure removes damaged cartilage and bone from both sides of the joint and replaces them with prosthetic parts. Silicone, metal, or pyrocarbon components are commonly used to create a smooth, pain-free articulation while preserving the delicate balance required for precision movements of the hand.

This technique replaces only one portion of a finger or wrist joint while preserving healthy parts. The surgeon removes and replaces only the damaged portion of the joint, leaving intact the undamaged opposing surface. This approach preserves more natural bone stock and may allow for more normal joint kinematics in the hand. It is particularly useful for certain metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint reconstructions.

This method covers the damaged joint surface with a cap rather than removing substantial amounts of bone. The procedure preserves more of the patient’s original bone structure by simply reshaping the joint surface and covering it with a smooth cap. This technique is particularly useful for the carpometacarpal (CMC) joint of the thumb, where maintaining proper length and tension is critical for opposition movements.

This procedure replaces a previously implanted prosthesis in the hand or wrist that has worn out or developed complications. The surgeon removes the existing implant, addresses any bone loss, and installs a new prosthesis. Revision procedures often require specialised implants and techniques to address bone defects from the previous surgery while maintaining the precise biomechanics required for hand function.

The procedure begins with appropriate anaesthesia for patient comfort during hand surgery. General anaesthesia, which renders the patient unconscious, regional anaesthesia (such as an axillary or wrist block), or local anaesthesia with sedation may be used. The choice depends on the specific joints being replaced and patient factors.

The surgeon creates a precise opening to access the damaged joint in the finger, thumb, or wrist. The incision is carefully placed to provide adequate exposure while respecting the complex anatomy of tendons, nerves, and blood vessels that lie close to the joint.

Soft tissues are meticulously managed to reveal the joint surfaces while preserving the delicate balance of the hand’s biomechanics. Tendons and ligaments may be temporarily repositioned to provide adequate visualisation of the joint. 

The damaged portions of bone are removed to create surfaces that accommodate the specialised hand joint implants. Using specialised instruments, the surgeon removes arthritic bone and reshapes the remaining surfaces according to the implant design. 

The prosthetic components are secured in place using techniques appropriate for the specific hand joint. For finger joints, cemented silicone implants may be used, while thumb joints might receive press-fit metal and polyethylene components. 

The surrounding soft tissues are balanced to ensure joint stability while allowing appropriate motion. Ligaments may be tightened, released, or reconstructed to achieve the delicate balance required for optimal hand function.

The surgical site is carefully closed in layers to promote healing while minimising scarring on the hand. Deep tissues are repaired with absorbable sutures, while skin may be closed with fine sutures designed to leave minimal scarring. A protective splint or dressing is applied to protect the operative site during initial healing.

While hand joint arthroplasty has a high success rate, potential complications include infection, joint stiffness, and implant issues (loosening, fracture, or dislocation). The small size of hand joint implants makes them more vulnerable to mechanical problems than larger joint replacements. Other risks include nerve damage causing numbness or pain, tendon adhesions affecting finger motion, and persistent swelling. Complex regional pain syndrome (CRPS) is a rare but serious complication that can cause disproportionate pain and dysfunction.