Small Joint Replacement For Worn Damaged Joint Surfaces
What is Small Joint Replacement?
Arthritis commonly affects the small joints of the fingers and the base of the thumb. It can cause these joints to become swollen, stiff and painful. It often leads to joint enlargement, interfering with normal hand function and significantly affecting a person’s quality of life.
In severe cases where non-surgical measures have been exhausted, surgery may be required to fuse or replace the joints. There is the option to have fusion, which results in no pain, but also no movement at the finger joint. The other option is a joint replacement. Small joint replacements in the fingers provide reliable pain relief and can preserve but rarely increase range of movement.
How is small joint replacement performed?
The operation is performed as a day case either under general regional or local anaesthetic. An incision is made in the fingers, the diseased bone is removed and an artificial joint is inserted.
Joint replacement recovery
Following the surgery, the wound will be covered with a dressing and a plaster splint. The stability of the joint replacement at the end of the operation will determine the speed at which you can start to regain movement and strength.
Local anaesthetic is injected into the wound site at the end of the operation. The area will therefore remain numb for around 6 hours after the procedure. Prior to the anaesthetic wearing off, you should start taking pain relief regularly which will be prescribed to you.
Swelling will cause stiffness and pain which can be made worse by having your arm hanging down by your side. You should therefore keep your hand above the level of your heart for the first 48 hours.
You will be seen by a hand therapist within a few days of the procedure. The dressings will be removed and the wound will be checked. You will be fitted for a bespoke splint and given advice and exercises to start straight away. Keeping your hand elevated is important to prevent swelling and stiffness in the fingers.
You will be seen by your surgeon in clinic 2 weeks after the operation, and any visible stitches will be removed. After 2 weeks it is safe to get the hand wet. The wound and surrounding skin may become quite dry and will respond well to a moisturiser. Initially the scar will be thickened and tender to touch. This should be massaged firmly with a moisturising cream to reduce sensitivity and swelling.
You may be able to drive after 2 weeks as long as you feel comfortable and have full motion in your fingers.
Returning to work should be discussed with your surgeon or hand therapist as this will vary depending on your profession. The swelling will take 3-6 months to completely settle.
Joint Replacement risks
Any surgery carries a small amount of risk. The surgery has a very low risk but can include the following:
- Infection – if your wound becomes very red, hot and swollen, you should contact your GP immediately or visit your nearest A&E department
- Pain – This usually settles during the first week following the procedure and is usually moderate
- Stiffness – The joint being replaced in some cases is very stiff, which can sometimes lead to limited range of motion following the operation
- Swelling – the finger will have some swelling for 3-6 months following the procedure
- Nerve injury – Localised numbness around the wound site may occur. It usually resolves with time
- Dislocation – This is a short term risk before the tissues tighten. The risk is very low, but if it does occur, a short anaesthetic is required to relocate the joint
- Loosening – This is a long term complication of the joint replacement. When the joint is loose, it may become painful and swollen. At this stage the majority of patients will have their joint replacement converted to a fusion
The One Team Specialists
Anthony Hearnden
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Shoulder, Elbow, Hand and Wrist
