The PIP joint is one of the most common digits of the hand to develop arthritis, causing severe disability. The hand is designed to make a fist, and with PIP joint arthritis, pain and stiffness impacts this function. The PIP joint can be replaced to maintain movement and return pain free function to the hand.
There are two types of replacements. One is a surface replacement, similar to a knee replacement, where the surfaces are restored to their normal anatomy. The other is a silicone replacement which allows better movement, but less stability.
PIP replacements have been proven to be a very good surgical intervention for patients with long-term osteoarthritis or rheumatoid arthritis of the PIP joints.
Metacarpophalangeal (MCP) joints very rarely develop osteoarthritis, however, are the first joints affected in rheumatoid arthritis, where the fingers drift towards the little finger side or ulnarly due to fatigue of the ligaments.
However, secondary trauma and hemochromatosis may also cause arthritis in this joint. The MCP joint also lends itself to a replacement procedure. A silicone prosthesis is used allowing excellent range of motion and pain relief.
This procedure is paired with a ligament reconstruction.
The wrist is by far the most complicated joint in the body with 10 bones articulating together. A successful wrist replacement ,that endures the test of time, was therefore never going to be an easy task to develop. Wrist replacements now have revolutionized the treatment of wrist arthritis, especially in rheumatoid as well as osteoarthritic type conditions.
Previous surgical treatment for arthritic wrist pain has been a wrist fusion. However, research has shown that wrist fusions are generally not well tolerated and that maintaining movement of the wrist is an essential part of the general function of the hand.
The total wrist replacement prosthesis that I currently use is the Motec system.
The base of thumb joint is very unique, described as a saddle joint with the metacarpal bone riding on a satellite trapezium.
This joint is commonly the first joint in the body to develop arthritis possibly due to the excessive use of the hand as a tool. However, there is no real explanation as to why arthritis develops first in this joint.
Once arthritis develops between the trapezium and the metacarpal, the hand is severely disabled as the thumb constitutes 60% of the hand’s function. The replacement of the CMC joint involves an osteo-integrative prosthesis, with a ball and socket joint that restores function and relieves pain.
This procedure produces positive results with return of function and strength in the hand.
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