Arthritis in the fingers, whether from degenerative osteoarthritis or inflammatory conditions like rheumatoid arthritis, can cause significant damage to the joints. This damage often results in chronic pain, stiffness, and a progressive loss of hand function. When non-surgical treatments are no longer effective, a range of surgical procedures is available to restore stability, improve movement, and provide lasting pain relief for the affected joints.
Criteria for Surgical Intervention
The decision to proceed with surgery is reserved for patients whose condition has reached a threshold of severity and unresponsiveness to other treatments. A primary factor is severe, debilitating joint pain that significantly interferes with normal hand activities and is not adequately managed by conservative measures. This pain must persist despite consistent efforts involving rest, anti-inflammatory medications, splinting, or corticosteroid injections.
The degree of functional limitation is also important, particularly an inability to grasp, pinch, or perform tasks requiring fine motor skills. Physicians also review X-ray evidence showing advanced joint destruction, such as complete loss of cartilage space or significant bone-on-bone contact. When these criteria are met, surgery becomes the next step to address the structural damage.
Types of Procedures for Finger Arthritis
Surgical treatment for finger arthritis is highly specific and depends on the joint affected and the functional goal, typically falling into one of three main categories. The first option is Joint Fusion, known as arthrodesis, which aims to eliminate pain completely by surgically joining the two bones that form the joint. This procedure is favored for the distal interphalangeal (DIP) joint, which is the joint closest to the fingertip, and the interphalangeal joint of the thumb, where stability and a strong pinch grip are prioritized over movement.
Arthrodesis permanently stabilizes the joint by removing the damaged cartilage and holding the bone ends together with pins, plates, or screws until they fuse into a single solid unit. Although motion is lost at the fused joint, the resulting stability provides a pain-free foundation for the rest of the finger’s function. The final position of the finger is chosen carefully to optimize hand function for activities like gripping and holding objects.
The second major category is Joint Replacement, or arthroplasty, which focuses on preserving or restoring motion while relieving pain. This approach is most commonly used for the metacarpophalangeal (MCP) joints, which are the knuckles at the base of the fingers, and sometimes for the proximal interphalangeal (PIP) joints in the middle of the finger. During this surgery, the damaged joint surfaces are removed and replaced with an artificial implant.
Implants are made from materials like silicone, pyrocarbon, or metal and plastic components. Silicone implants have been widely used, but modern designs utilizing pyrocarbon offer a balance of flexibility and durability, particularly in the PIP joints. The selection of the implant material and type is determined by the patient’s age, activity level, and the specific joint being addressed.
The third type of procedure, Excisional Arthroplasty, is most often performed at the base of the thumb on the carpometacarpal (CMC) joint, also known as the basal joint. This joint is highly susceptible to wear-and-tear arthritis. The procedure, commonly called a trapeziectomy, involves removing the entire trapezium bone, one of the small wrist bones involved in the thumb joint.
Removing the trapezium creates a space between the metacarpal and the scaphoid bones. This void is often filled with a rolled-up segment of the patient’s own tendon, creating a soft tissue cushion, a technique known as ligament reconstruction and tendon interposition (LRTI). This technique provides pain relief while maintaining significant thumb mobility, crucial for pinching and grasping.
The Recovery and Rehabilitation Process
The initial post-operative period is focused on managing pain, controlling swelling, and protecting the surgical site. Patients can expect the hand to be immobilized in a splint or cast for several weeks, and elevation of the hand above the heart is encouraged to minimize swelling. Prescription pain medication is used initially, with the goal of transitioning to over-the-counter anti-inflammatory drugs as healing progresses.
The approach to rehabilitation differs based on the procedure performed. For joint fusion, the goal is bone healing, so the finger is kept immobilized in a cast or splint for approximately six to eight weeks until the fusion is confirmed by X-ray. Therapy during this time focuses on maintaining the range of motion in the joints that were not operated on, such as the wrist and elbow.
In contrast, joint replacement requires early and progressive mobilization to prevent stiffness and maintain the new joint’s range of motion. Physical or occupational therapy often begins within the first week or two after surgery with controlled, gentle exercises. The therapist guides the patient through a progressive program over the next three to six months, balancing protection with the need to restore dexterity and strength.
Full recovery can take several months, with complex procedures like joint replacement requiring six months or more to achieve maximum functional return. Joint replacement aims for improved motion, whereas fusion provides lasting stability. Adherence to the prescribed hand therapy is a strong determinant of the final outcome, ensuring the best possible return to daily activities.