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Small Joint Replacement

Small Joint Replacement

The hand and fingers contain several small joints that allow delicate, precise, and coordinated movements. These joints are essential for gripping, writing, typing, and performing fine motor tasks. When these joints are damaged by arthritis, trauma, or congenital conditions, they can become painful, stiff, and deformed, leading to severe loss of function. In such cases, small joint replacement surgery provides a reliable option to restore mobility, relieve pain, and improve quality of life.

What is Small Joint Replacement?

Small joint replacement, also called arthroplasty, is a surgical procedure in which a diseased or damaged joint of the hand or finger is replaced with an artificial implant. These prosthetic joints are designed to mimic the movement of natural joints while reducing pain and improving hand function.

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Indications for Small Joint Replacement

Surgery is recommended when conservative treatments (medications, splints, physiotherapy, or steroid injections) no longer provide relief. Common conditions requiring small joint replacement include:

1. Rheumatoid Arthritis

  • A chronic autoimmune disease causing joint destruction, pain, and deformity.
  • MCP and PIP joints are often affected.

2. Osteoarthritis

  • Degenerative joint disease due to wear and tear.
  • Common in the thumb CMC joint.

3. Post-traumatic Arthritis

  • After fractures or ligament injuries, joints may become stiff and arthritic.

4. Congenital Abnormalities or Severe Deformities

  • Rarely, small joint replacement is used to restore function in birth-related hand deformities.

5. Failed Previous Surgeries

  • Such as unsuccessful fusion or reconstruction procedures.

Types of Implants

Several types of prosthetic joints are available, depending on the joint involved and patient needs:

1. Silicone Implants

  • Most widely used, especially in rheumatoid arthritis patients.
  • Flexible, simple to insert, and effective in relieving pain.

2. Metal and Plastic Implants

  • Made of cobalt-chrome, stainless steel, or polyethylene.
  • Provide more stability and durability for higher-demand patients.

3. Pyrocarbon Implants

  • Designed to mimic the natural joint surface.
  • Provide good strength and motion but require precise surgical technique.

The choice of implant depends on patient age, activity level, underlying condition, and surgeon preference.

Surgical Procedure

1. Anesthesia & Preparation

  • Performed under regional or general anesthesia.
  • The surgical site is sterilized and prepared.

2. Incision

  • A small incision is made over the affected joint.

3. Removal of Damaged Joint

  • Diseased cartilage and bone surfaces are carefully removed.

4. Insertion of Prosthesis

  • The artificial implant is placed in position, usually fixed within the bone ends.
  • It is checked for proper alignment and motion.

5. Closure & Dressing

  • The wound is closed with sutures, and a protective splint or dressing is applied.

The surgery typically lasts 1–2 hours, depending on the number of joints replaced.

Benefits of Small Joint Replacement

  • Pain Relief: One of the most significant benefits.
  • Improved Function: Restores grip, pinch strength, and dexterity.
  • Correction of Deformity: Straightens crooked fingers and improves appearance.
  • Enhanced Quality of Life: Enables patients to perform daily tasks independently.
  • Alternative to Fusion: Unlike joint fusion (arthrodesis), replacement preserves mobility.

Risks and Complications

As with any surgery, risks exist, though modern techniques have made complications less common:

  • Infection at the surgical site.
  • Loosening, breakage, or wear of the implant over time.
  • Joint instability or dislocation.
  • Stiffness or reduced range of motion despite surgery.
  • Allergic reaction to implant material (rare).
  • Recurrence of deformity in progressive diseases like rheumatoid arthritis.

With careful patient selection and rehabilitation, most patients achieve excellent long-term results.

Outcomes and Long-Term Considerations

Small joint replacement does not restore the hand to a completely “normal” state, but it significantly reduces pain and improves mobility. Longevity of implants varies—silicone implants may last 10–15 years, while newer pyrocarbon or metal implants may last longer. Patients are usually advised to avoid heavy manual labor or high-impact activities that could strain the artificial joint.

Regular follow-ups are essential to monitor implant integrity and hand function. If necessary, revision surgery can be performed.

Conclusion

Small joint replacement is a valuable surgical option for patients suffering from painful, stiff, or deformed finger joints due to arthritis, trauma, or disease. By replacing the damaged joint with an artificial implant, this procedure relieves pain, restores mobility, and improves hand function, allowing patients to regain independence in daily life. Though not without risks, advances in implant design and surgical techniques have made small joint replacement highly effective and durable. Combined with dedicated physiotherapy, it offers patients renewed hope for a functional, pain-free hand.

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