Rheumatoid arthritis damages the joints, ligaments and tendons in the hand. This causes distortion of the fingers and loss of movement in the joint.
Replacement of knuckle joints (MCPJ) with artificial silicone joints and straightening the fingers by realignment and/or transfer of the tendons.
You will be initially placed in a bulky dressing, consisting of gauze, wool and crepe bandage to rest the hand. A small tube (drain) may be left in the wound to allow any blood to escape.
The operation is usually performed under general anaesthetic. Local anaesthetic is often injected into the arm at the end of the operation. The fingers will remain numb for up to ten hours after surgery. As this effect wears off, it may be worth taking some pain killers. You will stay in hospital for one night after your operation.
Hand elevation is important to prevent swelling and stiffness of the fingers. Please remember not to walk with your hand dangling, or to sit with your hand held in your lap.
The dressing and drain will be removed after 24-72 hours and replaced by a light dressing to allow mobilization of the fingers. At this time, you will see the Occupational Therapist who will fit you with splints: dynamic for day-time, which allows movement of the fingers while protecting the tendon surgery with elastic supports; static for sleep, which rests the hand.
You will be seen by a physiotherapist who will instruct you on your exercise program.
You will be discharged after 3-5 days when the hand is moving well.
- After two weeks, you will be shown some passive exercises (using the other hand to help with movements).
- After four weeks, you will start using the hand without the protection of a splint during the day-time but keeping the static splint for the night.
- After eight weeks, you should be returning to normal activities and driving.
There will be some swelling and bruising. Look out for any redness or tenderness in the area around the wound which might indicate an infection. Do not apply antiseptic. At this stage, it is safe to get the hand wet in a bath or shower. The wound and the surrounding skin often become very dry and will be more comfortable if a moisturizer is applied. Your stitches will be removed between 2-3 weeks after the operation. Following this, the scar will be somewhat firm to touch and tender. This can be helped by massaging the area firmly with the moisturizing cream.
After the operation, movement in the joints averages 45º which is less than half that of a healthy joint. In general, complications are rare (overall 5%) and outcomes are satisfactory. Inevitably, the implants will not last forever and sometimes they need to be replaced. There can be a tendency for the fingers to become deviated again over the years.
- Wound Parts of the wound can break down and be slow to heal (3%)
- Infection Deep infections may not respond to antibiotics and may require removal of the implant (1%).
- Fracture Breakage of the implant becomes more likely with time but does not necessarily cause problems (5%)
- Bone wear Absorption of bone around the implant related to loosening (3%)
- Dislocation The implant can slip out of position or become unstable. Again, this does not necessarily cause problems (1%)
- Silicone Spread of silicone particles into the lymph glands causing enlargement (0.1%)
- Synovitis Inflammation of the joint lining due to fragmentation of the implant (0.05%)
- Removal The implant is removed if significant problems are encountered (see above). They can be replaced if needed later (3%).