You've probably heard of hip replacements and knee replacements but what about getting new knuckles?
Artificial knuckle joints can provide relief when arthritis in the finger joints causes pain, stiffness and difficulty grasping or holding objects.

Arthritis is the name for a group of conditions that affect the joints and, sometimes, other areas of the body. Two important forms are osteoarthritis and rheumatoid arthritis:

Osteoarthritis
Osteoarthritis (OA) is a condition characterized by a breakdown of cartilage in a joint. Cartilage is the tough, slippery tissue that covers and protects the ends of the bones in a joint, preventing the bones from rubbing or hitting each other during movement. In OA, the cartilage breaks down and wears away. Holes form in the cartilage, allowing the ends of the bones to touch and rub against each other. To protect itself from damage, the bone thickens. Tiny bone spurs develop on the edges of the joint. Sometimes pieces of bone break off and float inside the joint.

According to the Arthritis Foundation, about 27 million Americans have OA. Risk increases with age. The most commonly affected joints are the hips, knees, hands, lower back and neck. Patients may complain of pain, swelling and stiffness in the affected joints, enlargement of the joint or a “crunching” feeling when moving the joint. OA of the hands may cause the development of bony growths on the middle or last joints of the fingers.

Rheumatoid arthritis
Rheumatoid arthritis (RA) is an inflammatory disease that occurs when the body’s immune system mistakenly attacks the lining of the joints. Initially, the lining swells, and then thickens. Eventually, the inflammatory cells in the joint release enzymes that eat away cartilage and bone. The destruction of joint structures causes the affected joint to lose its shape and alignment.

The Arthritis Foundation estimates RA affects about 1.3 million Americans. The condition can occur at any age (including childhood), but most commonly first develops in young to middle-aged adults. Women are affected about 2.5 times more often than men. Signs may include pain, warmth, stiffness and weakness in a joint, fatigue, loss of appetite, fever, and, eventually deformity of the joint. RA typically occurs in a symmetrical pattern. So if a joint on one side of the body is affected, so will the joint on the other side.

Treating Arthritis of the Fingers
When arthritis affects the fingers, in addition to pain and stiffness, patients may have difficulty picking up objects or holding them in their hands. Sometimes severe joint deformity occurs, leading to permanent disfigurement.

In early stages of arthritis, doctors will usually try supportive treatments, like rest, exercise, joint protection and medications. The goal of therapy is to relieve pain and improve joint function and quality of life. When those treatments don’t help, surgery may be recommended.

With the fingers, there are two main options for severe joint damage: fusion and replacement. In joint fusion, an incision is made in the skin over the joint. The ends of the bones are exposed and roughened. Then, donor pieces of bone are placed inside the joint. As the bones heal, the ends fuse, forming a single bone. Joint fusion eliminates the joint, and thus, the ability to move that part of the finger. However, it greatly reduces pain and improves quality of life.

Joint replacement is a procedure in which the damaged joint is surgically removed and replaced with an artificial joint. Kenneth Means, Jr., M.D., Hand Surgeon with Union Memorial Hospital in Baltimore, says artificial knuckle joints are typically made of silicone or metal. The type of replacement is typically dependent upon the level of activity and quality of the diseased joint. If patients don’t have a significant amount of deformity, a metal replacement may be used. But if the joint is seriously deformed and the ligaments are not healthy, a silicone replacement is usually preferred.

After a knuckle replacement, patients need therapy to regain range of motion and build strength in the joint. Means says patients may not regain full range of motion, but at least they will have relief from pain. About 70 to 80 percent of knuckle replacements last about ten years. Knuckle replacement can be done on any of the fingers. However, Means says the knuckle closest to the end of the fingers is often treated with joint fusion rather than replacement.

AUDIENCE INQUIRY
For information on arthritis:
Arthritis Foundation, http://www.arthritis.org
National Institute of Arthritis and Musculoskeletal and Skin Diseases, http://www.niams.nih.gov

For general information on joint replacement:
American Academy of Orthopaedic Surgeons, public website, http://orthoinfo.aaos.org

Research compiled and edited by Barbara J. Fister

© 2009 Medstar Television, Inc. All Rights Reserved
 

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