Finger joint arthritis
(PIPJ arthritis)
What is finger arthritis?
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It occurs when the cartilage in the finger joint wears out.
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Eventually ‘bone on bone’ articulation occurs and bone spurs develop.
How does it present?
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The joints become larger.
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The joints commonly ache and swell.
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The fingers become stiff, especially after a period of rest. Often it is difficult to make a full fist.
Why does it happen?
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Osteo arthritis is mostly genetic (runs in families)
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Injuries that cause instability or breaks that result in a step in the joint surfaces both can cause arthritis in the long-term
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Inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis etc. can also result in worn out joints.
What can be done?
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Avoid activities that hurt and find other ways to do them
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Take simple pain relief (such as paracetamol) and consider taking an anti inflammatory.
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A steroid injection into the worn joint can sometime relieve pain from acute flare ups.
When is surgery needed?
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When non operative treatment is unsuccessful and
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pain and weakness in the hand:
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stop you from doing the ‘things that you have to do’ such as getting dressed, making a meal, driving a car, or getting a good night’s sleep
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and/or the ‘things that you love to do’ in life such as fishing, crafting, or holding a book to read.
How does surgery work?
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This kind of surgery can be done under local anaesthetic (numbing the finger only) in hospital.
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The anaesthetist usually administers sedation (a ‘twilight anaesthetic’)
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Antibiotics is usually administered at the time of surgery but does not have to be continued after surgery.
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It is common to go home within a few hours of the surgery (day surgery)
What do we do in surgery?
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The operation is done through a curved incision on the back of the finger.
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The worn out joint surfaces and bone spurs are removed
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The surfaces are replaced with a metal and plastic (polyethylene) prosthesis.
After the Surgery
In Hospital
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The finger is placed in a plaster or thick bandage.
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It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling
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Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’, than ‘to catch’ up when it is severe.
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If the dressing feels to tight, ask to have the bandages cut and even remove the plaster if pain form a tight cast is severe.
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It is usual to leave hospital the same day as the surgery.
At Home
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Continue to elevate your arm until swelling in your fingers subside.
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Keep the wound dry, covered and clean.
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Make an appointment with a hand therapist (within a 3-5 days)
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A combined appointment with hand therapy and your surgeon is usually arranged for about 2 weeks after surgery.
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Please do not drive before speaking to hand therapy or a doctor.
The recovery
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A splint is usually used for about 6 weeks
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A hand therapist will show you how to do gentle range of motion exercises with the help of a splint in this time.
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Most moderately heavy activities can usually be achieved by 3-4 months, but scarring around the finger can take 6 -9months to become completely comfortable
Time frames
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Self care (washing, dressing, eating) with the operated hand – usually around 2 weeks (a splint is still needed)
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Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 4-8 weeks post surgery)
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Golf, fishing, cycling etc.: usually around 3-4 months, but it can be longer (6 months)
What can go wrong?
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Infection occurs rarely (1% of the time), but can be severe. It may need further operations, weeks in hospital. It can lead to a poor outcome.
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Damage to the nerves or blood vessels to the fingers can (rarely) occur. It can lead to numbness and ongoing pain.
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Severe scarring and stiffness can occur leading to a very stiff finger.
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The joint can become unstable, it can wear out, become loose and the bone around the implant can break.
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Repair of the tendon that straightens the finger (which is a routine part of the surgery) can fail, resulting in a finger that does not straighten out completely.
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The complications mentioned above are rare, but may necessitate revision surgery, fusion of the joint, or (in extreme cases) amputation of the finger.
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Very rarely (around one in a thousand) a severe pain reaction(CRPS) can develop, which can be disabling for years.
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An anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.
What can you expect the final outcome to be?
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Finger joint replacement has a high success rate and most patients are very happy.
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Pain is usually significantly improved, if not cured completely
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Mobility in the finger is usually improved compared to before the operation, although it will not be normal.
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The joints replacements are usually expected to last at least 10 years.