Small Joint Replacement


What is small joint replacement surgery? This is a surgical procedure performed to control arthritis and other hand conditions. As you may know, arthritis in the hands can cause severe functional deficit and chronic pain. Arthritis can further affect your knuckles (on the fingers) and your thumbs (at the base).

During the surgical procedure, the abnormal structures of your joints are removed or replaced. These structures include the bones, cartilage, and synovium. The removal of these tissues helps get rid of painful worn-out bone surfaces. Plus, this procedure creates room for new artificial parts, medically referred to as implants. Artificial implants are inserted surgically into the prepared bones.

More often, implants come in the form of plastic, metal, or specific types of carbon-coated materials. Once they are in place, implants allow your bones to move freely without pain. Usually, the replacements are inserted carefully into the middle joints of your finger, also referred to as proximal interphalangeal or simply PIP. 

Implants can also be inserted into your knuckle joints right at the base of your finger, where it forms a joint with your hand. In medical terms, the knuckle joints are called metacarpophalangeal or MP. The only exceptional case here is the thumb due to high lateral forces. These forces make implants in the thumb fail quickly. Regardless, the thumb metacarpophalangeal joint is fused despite being too painful.

It is also common for the implants to be inserted into your wrist, especially at the carpus and into the distal radius. For the elbow, you should expect a total elbow replacement. This procedure is performed to replace the distal humerus and proximal ulna. 

Unfortunately, fingertips joints cannot receive implants because they are too small. Instead, they are often fused in cases where arthritis is too painful and severe. Artificial joints or implants in your hand may help in the following ways:

  • Restoration or maintenance of joint motion
  • Reduction of joint pain
  • Improvement of overall hand function
  • Improvement of the look and alignment of your hand joints

Causes and Symptoms of Small Joint Replacement

The normal joint of your fingers and hands has bones with smooth surfaces thanks to articular cartilage on the ends of bones. The cartilage allows bones in the joints to glide against each other smoothly as the synovial fluid reduces friction between the bones by constantly greasing the joints. 

Worn-out articular cartilage is the main cause of problems experienced in the joints. Therefore, a joint replacement may become necessary to prevent pain and promote the functionality of your fingers and hands. This wearing out of your articular cartilage is caused by abnormal joint fluid or damage to the joint. As a result, the joints become too stiff to move and painful, causing arthritis. 

Symptoms of arthritis are as follows:

  • Swelling
  • Stiffness
  • Pain in the fingers and the hand
  • Warm and tender joints of your fingers and hands
  • Deformities such as crooked fingers and enlarged knuckles

There are up to three joints within your fingers with different treatment needs. They include the distal interphalangeal (DIP), the proximal interphalangeal joint (PIP), and the metacarpophalangeal (MP) joint. 

At Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, Christopher Sforzo will attend to your small joint replacement needs. Doctor Christopher L. Dillingham is a board-certified orthopedic surgeon with many years of experience treating shoulder, elbow, arm, forearm, hand, and wrist joint replacement problems. 

Small Joint Replacement Diagnosis 

During diagnosis of small joint replacement, your doctor will perform the following tests:

  1. X-ray: This is an imaging test that provides your surgeon with detailed information about the affected joints. X-ray images come out in black and white with varying intensity to reveal details of your finger or hand joints. 
  2. MRI: Commonly known as magnetic resonance imaging, MRI is a non-invasive medical test that doctors use to diagnose joints of hands and joints of fingers before surgery. MRI uses computer-generated radio waves and powerful magnetic fields to provide detailed images of the affected joints.

Small Joint Replacement Treatment

After a successful diagnosis of your joint problem, the doctor will decide whether to use a nonsurgical or surgical treatment option.

The Procedure of Small Joint Replacement Surgery

Usually, this type of surgery is carried out under general or local anesthesia. The procedure lasts about 1-2  hours, and it involves the following steps:

  1. Your orthopedic surgeon makes a cut on the back of your finger joint.
  2. Once the cut is made, the soft tissue is spread out to make the joint visible.
  3. The surgeon proceeds to cut the bone ends that make up the finger joint to create a flat surface.
  4. A small cutting tool known as a “burr” is used to create a small opening in the exposed bones of your finger joint.
  5. Your surgeon shapes and inserts the prosthesis to fit snugly in both sides of your finger bone. 
  6. The surgeon repositions the nearby ligaments to wrap the finger joint for support.
  7. The soft tissue is stitched back in position.
  8. Finally, the doctor secures your finger in a bandage and splint. 

Risks of Joint Replacement Surgery

Like all other major surgical procedures, small joint replacement surgery has potential risks. Some of the risks involved include:

  • Infection
  • Pain
  • Stiffness
  • Swelling
  • Nerve injury
  • Dislocation of the new artificial joint
  • Loosening of joint replacement

Make sure to contact your surgeon if the operated area becomes hot, red, crooked, or painful. Do the same if you experience sudden severe pain and swelling around the finger. 

Post-Operative Care of Small Joint Replacement Surgery

After the surgery, your finger will be splinted and bandaged to help keep it straight throughout the healing process. Apart from that, your hand or finger may be placed in a cast for three weeks. 

Don’t use the operated hand to do strenuous or excessive work because the joints can get damaged. Make sure to visit your caregiver at least five days after your surgery. Remember to keep the operated arm popped up to prevent swelling and throbbing. Finally, you may turn to physical therapy to gain strength and mobility of the finger joint.

Final Thought

Artificial finger joints and other forms of small joint replacement play an essential role in relieving pain and restoring functionality among patients with arthritis. Even though minor risks and complications are expected after the surgery, patients can always look forward to positive results. 

So, if you are one of them, make sure to follow your healthcare provider and therapists’ instructions for the best results. Call your surgeon whenever you experience an increase in pain, swelling, and change in function. If you have any specific questions about wrist joint replacement, thumb joint replacement, or hand joint replacement surgery, contact Dr. Christopher Sforzo at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine today.