Houston Methodist. Leading Medicine

Hand FAQ

Question:

I've been told by several friends I met at the rheumatology clinic I go to that their finger replacements just didn't hold up like they thought they would. It's been recommended that I get a finger joint replacement for the middle joint of my middle finger. Should I do it? Will it last?

Answer:

Finger joint replacements have been around for quite a while but the design and materials are still in need of some improving. It's a small joint that gets a lot of use so the implants get a real workout. It's not uncommon for patients who have finger joint replacements to develop complications. Joint stiffening, implant loosening, squeaking, dislocations, and fractures are just a few of the problems reported by patients. Early reports after the type of interphalangeal (IP) joint replacements you are thinking about said, 'Yes! Good results!" But the authors of a recent long-term study reported differently. In that study, one surgeon replaced 31 IP joints in the hands of 17 patients and then followed them for at least two years. Most were followed for an average of four years (or more). Results were measured using pain, finger joint motion, finger and hand function, and X-ray findings. X-rays were used to look at alignment of the implants including subsidence (sinking of the implant down into the bone) and implant failure (fracture, dislocation). Activities of daily living and patient satisfaction were also assessed as important outcome measures. What they found was that like the results reported from other studies, in the early months, patients experienced significant improvements in pain, motion, and function. But over time, significant problems developed. Pain persisted. Complications occurred that required additional surgeries. For example, there were five joint dislocations, one fracture, and 11 complaints of finger squeaking. Some joints just wouldn't move at all while in others the implant loosened creating an unstable joint. In quite a few cases, the implant shifted and moved until it had migrated right out of the bone! The surgeon performing the study attributed these complications to the particular type of implant he was using (a pyrolytic carbon resurfacing joint replacement). When he tallied up all the problems and saw how unhappy his patients were with the results, he stopped using this particular type of implant. The material (pyrolytic carbon) is supposed to wear well and last a long time. It has the added advantage of stimulating bone growth, which is important to help the body create a stable implantation. But as the results of this study show, the benefits didn't last. Silicone implants may have a better track record. It might be best to talk with your rheumatologist and the hand surgeon who would do the surgery. Express your concerns based on what you've been told by other patients. See what they have to say about your particular situation. Each patient is different and those differences can sometimes account for better (or worse) outcomes. Find out what you can expect and what factors you might have that would predict a good (or possibly poor) result. It's not always a good idea to base everything on the reports of one or two patients -- but what they had to say is worth investigating before making any final decisions for yourself. Thomas M. Sweets, MBA, MD, and Peter J. Stern, MD. Pyrolytic Carbon Resurfacing Arthroplasty for Osteoarthritis of the Proximal Interphalangeal Joint of the Finger. In The Journal of Bone and Joint Surgery. August 3, 2011. Vol. 93-A. No. 15. Pp. 1417-1425.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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