Arthritis Surgery in Hands Wrists and Elbows
What is arthritis surgery?
Arthritis surgery consists of a synovectomy procedure in which the joint is cleaned of inflammation, a joint arthroplasty where the joint is replaced, and an arthrodesis procedure where the joint is fused stiff.
A joint synovectomy usually provides only temporary relief. An joint replacement is a procedure that involves replacing a joint with an artificial joint made of a metal such as titanium in the wrist and elbow or the fingers using silicone or a metallic pyrocarbon implants, or removing the joint and replacing with a tendon from your own body such as with basilar thumb arthritis.
When is arthritis surgery performed?
Any condition that can lead to joint destruction such as common degenerative joint disease or osteoarthritis or less commonly trauma, rheumatoid arthritis, etc. will ultimately lead to pain, stiffness and deformity. The track record for small joint replacement for arthritis surgery is not nearly as beneficial long term as with larger joint replacements in the hip and knee due to loosening or breakage. Nevertheless in a patient with severe arthritis at certain joints such as the MCP and PIP joint of the fingers of the hand and patients with involvement of both wrists a joint replacement is usually preferred over a joint fusion or arthrodesis. In many cases a joint replacement if it fails can be converted into a fusion as a last resort. In single wrist arthritis, usually from trauma, a partial arthrodesis fusing only part of the bones preserves part of the wrist movement in favor over a total arthrodesis of the wrist which is uncommon. In the elbow neither a replacement or joint arthrodesis should be performed if possible as the replacement usually doesn’t hold up to the demands of an active individual and an arthrodesis significantly limits function. Elbow arthrscopy may buy some time in making this decision.
SLAC 4-Corner arthrodesis
Who should perform arthritis surgery?
Arthritis surgery should be performed by surgeons with knowledge of not only performing the surgery but when to perform such an aggressive reconstructive hand procedure. Dr. Knight’s knowledge of reconstructive upper extremity surgery, allows him to first make sure all conservative treatment has been exhausted and then carefully assess your needs in activities of daily living, work, hobbies and sports to come up with a solution that is right for you.
MCP joint replacement of all finger on the left hand of a patient with rheumatoid arthritis compared to right side prior to replacement.
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