Houston Methodist. Leading Medicine

Hand FAQ

Question:

I am one of the few "lucky ducks" (NOT!) in the world to get osteoarthritis of my middle knuckle of the right hand. I've been told this is an uncommon problem. And to add insult to injury, after months of hand therapy, medications, and even steroid injections, I ended up no better off than before treatment. So I had a joint replacement with a special carbon implant. Wouldn't you know it? I still have very limited motion and pain no one can explain. Am I unusual as well as unlucky? What would you say about my case?

Answer:

As you know, for people with osteoarthritis (OA) of the metacarpophalangeal (MCP) joints (the knuckles), pain, stiffness, and deformity can lead to disability and loss of function. Quality of life is affected as the individual is unable to participate in work, play, or daily activities. Fortunately for most people, this condition (osteoarthritis of the MCPs) is uncommon. Just as you have experienced, treatment begins conservatively with hand therapy, medications to control pain and inflammation, and sometimes steroid injections. Surgery is a last resort type of option but consists of joint replacement. The use of implants for MCP joint replacement isn't new (they've been around 20 years or more) but the number of studies reporting on long-term results is fairly low. We know that motion is significantly improved from before surgery to after with this type of joint replacement. Grip strength is usually better than before surgery but often less than the other hand. Pain (when present) is reported as 'mild' (rated as a one on a scale from zero to 10). And even though the studies are small, the majority of patients are fully satisfied with the results. There have some problems reported along the way. Clicking and squeaking may develop when the joint is moved. Joint stiffness, constant pain, and squeaking can occur for no apparent reason. X-rays show that most patients have a little subsidence (implant sinking down into the bone) but this does not continue to get worse and presents no particular problems. In general, long-term results of surgical placement of carbon implants in the metacarpophalangeal (MCP) joints of the hand are positive. Symptoms improve, satisfaction is high, and the implants hold up well. Patients are able to get back to work and/or daily activities requiring the full use of the fingers and hands. Reasons for less than satisfactory results or outright failure remain unclear and deserve further attention through future studies. In your case, you may want to seek a second opinion in case there is an identifiable cause and possible treatment for your continued symptoms. Lindley B. Wall, MD, and Peter J. Stern, MD. Clinical and Radiographic Outcomes of Metacarpophalangeal Joint Pyrolytic Carbon Arthroplasty for Osteoarthritis. In The Journal of Hand Surgery. March 2013. Vol. 38A. No. 3. Pp. 537-544.

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