Pagpapalit ng Kasukasuan ng Knuckle (MCPJ) Impormasyon In-depth Pahintulot

Bakit iminungkahi ang operasyong ito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay nagsisimula sa mga opsyon na hindi gaanong invasive na angkop sa iyong kondisyon. Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sa iyong appointment, kumukuha kami ng history, sinusuri ang iyong kamay, at nag-aayos ng imaging kung kinakailangan. Sinasabi nito sa amin kung ano ang nangyayari sa joint.

Pinapalitan ng operasyong ito ang knuckle joint, ang joint kung saan ang iyong daliri o thumb ay nakakabit sa iyong kamay, ng isang artificial implant. Karaniwan itong inaalok kapag ang joint surface ay malubhang gasgas dahil sa arthritis at ang ibang mga gamutan ay hindi nagbigay ng sapat na ginhawa. Para sa mga matagal nang problema sa wear-and-tear, karaniwan muna naming sinusubukan ang non-operative care: pagbabago sa aktibidad, physiotherapy o hand therapy, at splinting. Isinasaalang-alang ang surgery kapag ang mga hakbang na iyon ay hindi nakatulong nang sapat. Ang layunin ay pag-alis ng sakit, mas mabuting function, at proteksyon ng mga katabing joints. Para sa ilang tao, ibinabalik din nito ang stability sa isang joint na naging maluwag o nabaluktot ang hugis.

Bago ang operasyon

Sa mga linggo bago ang operasyon, kinukumpirma namin ang plano gamit ang mga bagong imahe ng iyong kamay, gaya ng X-ray, MRI o ultrasound. Ipinapakita nito sa amin ang gasgas na kasukasuan at tinutulungan kaming pumili ng tamang implant. Makakatanggap ka ng malinaw na mga tagubilin tungkol sa pag-aayuno: walang pagkain o inumin pitong oras bago ang iyong operasyon. Humihingi kami ng pitong oras sa halip na mas maikling oras upang ang iyong operasyon ay maaaring isagawa nang mas maaga kung maagang matapos ang listahan sa theatre. Ang ilang mga gamot ay kailangang itigil muna bago ang operasyon, at sasabihin sa iyo ng iyong surgeon kung alin ang mga ito at kailan. Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo ng mga blood test o pagsusuri kasama ang anaesthetist. Sa araw ng operasyon, magdala ng listahan ng iyong mga kasalukuyang gamot, mag-ayos ng sasakyan pauwi, at magsuot ng komportableng damit na may maluluwag na manggas.

Sa araw ng operasyon

Darating ka sa surgical admissions unit ng ospital, kung saan ka ire-rehistro at ihahanda para sa theatre. Makikilala mo ang anaesthetist, ang doktor na mamamahala sa iyong anaesthetic at pain control habang nag-o-operasyon. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic. Minsan ay nagdaragdag ng regional nerve block para sa post-operative pain relief; tatalakayin ito ng anaesthetist sa iyo sa araw na iyon. Pagkatapos ay dadalhin ka sa operating theatre, kung saan isasagawa ang operasyon.

Kapag tapos na ang operasyon, magigising ka sa recovery area. Babantayan ka ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable ka na, ililipat ka sa ward o uuwi sa parehong araw, depende sa procedure at kung paano ang iyong recovery.

Ano ang kinapapalooban ng operasyon

Gagawa ang iyong surgeon ng maliit na hiwa sa likod ng iyong knuckle joint upang maabot ang mga gasgas na surface ng joint. Tatanggalin at huhubugin ang mga sirang dulo ng buto upang magbigay-daan para sa implant. Ang pinakakaraniwang implant ay isang flexible spacer na inilalagay sa pagitan ng dalawang buto, na nagpapahintulot sa joint na muling mabaluktot habang binabawasan ang sakit. Ang layunin ay paginhawa mula sa sakit, mas mabuting paggalaw, at proteksyon ng mga katabing joint.

Iba't ibang implant ang angkop sa iba't ibang joint at iba't ibang problema. Para sa ilang tao, ginagamit ang isang soft silicone spacer. Para sa iba, lalo na kung malakas ang mga nakapaligid na ligament at nagbibigay ng suporta ang mga katabing daliri, pinipili ang isang mas matigas na implant na hugis natural na surface ng joint. Pipiliin ng iyong surgeon ang implant na angkop sa iyong joint at sa iyong kondisyon.

Kapag nailagay na ang implant, susuriin ng iyong surgeon kung nakalinya nang tama at gumagalaw nang maayos ang daliri, at babalansehin ang mga soft tissue sa paligid ng joint upang manatili itong stable. Isasara ang hiwa gamit ang mga tahi at tatakpan ng dressing. Ang dressing ay mananatili nang humigit-kumulang 10 araw, na ipinapaliwanag sa seksyong 'Pagkatapos ng operasyon'.

Para sa ilang thumb knuckle joint, ang pagdurugtong ng mga buto (isang fusion) ay isang alternatibo sa implant. Tinatanggal nito ang masakit na joint ngunit nangangahulugan na ang bahaging iyon ng thumb ay hindi na mababaluktot. Tatalakayin ng iyong surgeon kung aling opsyon ang angkop sa iyong joint bago mo pirmahan ang consent form.

Pagkatapos ng operasyon

Magigising ka sa recovery ward, kung saan babantayan kang mabuti ng mga nurse habang nawawala ang bisa ng anaesthetic. Ang iyong kamay ay magiging nasa isang bulky dressing, at bibigyan ka namin ng pain relief upang mapanatili kang komportable. Dapat may kasama ka sa unang 24 oras pagkatapos mong makauwi. Maaari kang kumilos nang normal, ngunit dahan-dahan lamang at ipahinga ang iyong kamay na nakapatong sa unan kapag ikaw ay nakaupo. Sasabihin sa iyo ng iyong team kung uuwi ka sa araw ring iyon o mananatili ng isang gabi sa ospital. Pananatilihin namin ang dressing sa loob ng humigit-kumulang 10 araw; pakiusap na huwag itong tanggalin bago ang panahong iyon maliban kung sinabi namin sa iyo. Papalitan o tatanggalin namin ito kapag nakita ka namin.

Paggaling

Sa unang ilang araw, ang iyong kamay ay magiging masakit at mamamaga, at ang knuckle ay maaaring makaramdam ng paninigas at pagiging sensitibo. Ang pagpapahinga ng iyong kamay na nakataas sa isang unan ay nagpapababa ng pamamaga, at ang pain relief na ibibigay namin sa iyo ay magpapanatili sa iyong pagiging komportable. Ang discomfort ay unti-unting mawawala habang gumagaling ang joint.

Ang iyong kamay ay magiging nasa isang bulky dressing sa simula, na mananatili nang mga 10 araw. Kapag nakita ka namin, papalitan o tatanggalin namin ito at susuriin ang paggaling ng balat. Ang rehabilitasyon pagkatapos ng operasyong ito ay hand therapy kasama si Ruby Doolan sa Extend Rehabilitation. Gagabayan niya ang iyong mga ehersisyo at gagawa ng splint kung kakailanganin mo nito. Pinoprotektahan ng mga ehersisyo ang bagong joint habang bumabalik ang paggalaw ng iyong daliri o thumb, at tuturuan ka kung paano gamitin ang iyong kamay para sa mga pang-araw-araw na gawain nang hindi ito napupuwersa.

Habang humuhupa ang pamamaga, ang pagbaluktot at pagtuwid ay karaniwang nagiging mas madali. Kapag kaya mo nang humawak (grip) at kumuha (pinch) nang walang sakit, mapapansin mong ang mga pang-araw-araw na aktibidad tulad ng pagbibihis, pagkain, at pagsusulat ay nagiging mas natural. Maraming tao ang nakapapansin na ang pangunahing pakinabang ay ang pagkawala ng sakit na naranasan nila bago ang operasyon, kasama ang mas mabuting paggamit ng kamay para sa mga pang-araw-araw na gawain.

Hindi ka dapat magmaneho habang ang iyong kamay ay nasa splint o habang ikaw ay umiinom ng malakas na pain medication, at kailangan mong maging kakayahan na hawakan ang manibela gamit ang dalawang kamay at rumesponde sa isang emergency stop. Ang aming hiwalay na gabay sa pagmamaneho pagkatapos ng upper-limb surgery ay nagpapaliwanag kung kailan na ligtas ang bumalik.

Ang paggaling ay nag-iiba sa bawat tao, at ang iyong timeline ay maaaring magkaiba. Gagabayan ka namin sa bawat review, kasama ang iyong hand therapist.

Ano ang maaaring maging problema

Karamihan sa mga pasyente ay gumagaling nang maayos, ngunit paminsan-minsan ay maaaring magkaroon ng mga problema. Binabantayan kayo nang maigi ng inyong surgeon at ng team upang maagapan ang anumang isyu.

Hindi karaniwan ang impeksyon pagkatapos ng ganitong uri ng joint replacement. Bantayan ang balat sa paligid ng inyong sugat. Kung mapansin ang pamumula na kumakalat mula sa sugat, pag-init, paglabas ng likido (oozing), o malalim at tumitibok na sakit na hindi nawawala sa simpleng painkiller, makipag-ugnayan agad sa klinika. Kung nakararamdam ng lagnat o hindi mabuti ang pakiramdam, pumunta sa emergency department.

Ang bagong joint ay maaaring mawala sa puwesto paminsan-minsan. Ito ay tinatawag na dislocation. Maaari kayong makaramdam ng biglaang paggalaw sa joint, kung saan ang daliri o thumb ay nasa kakaibang anggulo at hindi gumagalaw nang normal. Tumawag agad sa klinika kung mangyari ito.

Ang implant mismo ay maaaring mapudpod, lumuwag, mag-crack, o mabali sa paglipas ng panahon. Ang mga palatandaan ay kinabibilangan ng pagbabalik ng sakit na dati nang nawala, bagong pag-click o pag-grinding, o ang paglihis ng daliri mula sa linya. Ipaalam ang mga pagbabagong ito sa inyong susunod na review, o tumawag nang mas maaga kung bigla itong nangyari.

Ang mga buto sa paligid ng implant ay maaari ring mabali habang isinasagawa ang operasyon. Sinusuri ito ng inyong surgeon bago kayo lumabas ng theatre, at karaniwan itong gumagaling sa pamamagitan ng mas maikling panahon ng proteksyon gamit ang splint.

Kung magkaroon ng problema, kung minsan ay kinakailangan ang karagdagang operasyon upang ayusin ito. Maaaring mangahulugan ito ng muling pagpapalit ng implant, o, kung hindi angkop ang pagpapalit, ang pagdurugtong sa mga buto ng joint na iyon upang gumaling ang mga ito bilang isang solidong piraso. Ang pangalawang opsyon na ito ay nag-aalis ng sakit ngunit pinipigilan ang pagbaluktot ng joint. Ipapaliwanag ng inyong surgeon kung ano ang angkop sa inyong sitwasyon kung sakaling mangyari ito.

May ilang tao na nakapapansin ng patuloy na paninigas o panghihina sa daliri o thumb pagkatapos ng operasyon. Nakatutulong ang hand therapy dito, kaya banggitin ito sa inyong mga review appointment sa halip na maghintay.

Ang complications table sa pahinang ito ay naglilista ng mga tipikal na rate kung nais ninyo ang mga detalye.

Kailan dapat tumawag sa amin

Karamihan sa mga problema ay lumalabas sa unang ilang linggo, kaya mahalagang malaman kung ano ang dapat bantayan. Tumawag sa amin kung mapansin ang pamumula na kumakalat mula sa sugat, pagtagas ng likido, lagnat, o pananakit na patuloy na lumalala. Pumunta sa emergency kung nakararamdam ng lagnat at hindi mabuti ang pakiramdam, o kung ang iyong binti (calf) ay namamagâ at maselan kapag hinahawakan. Ang biglaang pagkapos ng hininga ay nangangailangan din ng emergency care. Tumawag sa amin agad kung ang iyong daliri o hinlalaki ay biglang naalis sa puwesto, nakaposisyon sa kakaibang anggulo, o kung hindi mo ito maigalaw. Ang pamamanhid o pangingilig na hindi nawawala ay nangangailangan din ng agarang pagsusuri. Kung nag-aalinlangan, tumawag sa amin.

Higit pang detalye

Advanced reading: the deeper science (optional)

Ang seksyong ito ay higit pa sa kailangan mo para sa iyong sariling mga desisyon sa paggamot. Ang pagpapalit ng knuckle joint ay sulit sa karagdagang pagbabasa dahil sa isang kuryosidad: ang implant na pinakagamit ngayon ay esensyal na ang disenyong ipinakilala noong 1960s, at ito ay tumagal nang higit pa sa bawat materyal na dinala upang palitan ito. Ang pag-unawa kung bakit ay nagpapaliwanag kung para saan talaga ang operasyong ito.

Hindi na-displace ang silicone

Isang pagsusuri noong 2026 sa metacarpophalangeal joint arthroplasty sa rheumatoid arthritis ang nagpapatunay na ang operasyon ay patuloy na gumaganap ng sentral na papel sa pamamahala ng rheumatoid hand, at sa kabila ng mga pagsulong sa teknolohiya ng implant, ang flexible silicone arthroplasty ay nagbibigay ng maaasahang functional at cosmetic improvement sa mga pasyenteng angkop na napili [1].

Ang animnapung taon ng materials science ay nakagawa ng mga alternatibong metal-plastic at pyrocarbon, at ang silicone spacer ay nananatiling reference standard. Hindi ito karaniwan sa joint replacement, kung saan ang mga hip at knee implant ay patuloy na binago sa loob ng parehong panahon.

Ang dahilan ay hindi ginagawa ng implant na ito ang trabahong ipinahihiwatig ng pangalan nito. Hindi nito muling binubuo ang surface ng joint upang ibalik ang bearing. Ito ay isang flexible spacer na nagpapanatili ng puwang at nagsisilbing internal splint habang ang scar tissue ay nabubuo sa paligid nito upang maging isang bagong capsule. Ang resulta ay dulot ng paggaling, hindi ng device, kung kaya't ang mas mahusay na bearing surface ay hindi kailanman nagresulta sa mas mabuting outcome.

Ang tapat na buod ng mga resulta

Ang isang pagsusuri ng implant arthroplasty sa mga kasukasuan ng daliri at thumb ay nagsasaad nito nang maayos: ang implant arthroplasty ay predictably na nagbibigay ng relief sa sakit at mataas na satisfaction, ngunit historically ay nagdusa mula sa mataas na rate ng mga komplikasyon, at habang ang mga materyales na metal-plastic at pyrocarbon ay nag-evolve, ang survivorship at reoperation rates ay nananatiling isang concern [2].

Mahalaga ang dalawang panig. Ang mga tao ay maaasahang nasisiyahan sa mga operasyong ito, nawawala ang sakit, bumubuti ang hitsura, mas gumagana ang kamay para sa mga pang-araw-araw na gawain, at ang mga implant ay may limitadong buhay na may totoong reoperation rate. Ang satisfaction at durability ay magkaibang katanungan, at ang operasyong ito ay may mas mataas na marka sa una.

Para sa osteoarthritis, manipis ang ebidensya

Karamihan sa mga literatura ay tungkol sa rheumatoid arthritis, dahil doon pinaka-dramatiko ang deformity na itinatama. Para sa osteoarthritis, mas mahina ang larawan: ang available na ebidensya ay binubuo ng mga retrospective cohort na may maliliit na sample size at relatibong maikling follow-up [3].

Kapansin-pansin, kung saan ang mga may-akda ay nagpapahayag ng kagustuhan para sa pyrocarbon kaysa sa silicone sa osteoarthritis, ito ay batay sa potensyal para sa pinabuting stability at alignment, kung saan ang data ay inilarawan bilang preliminary [3]. Ito ay isang makatwirang posisyon, ngunit dapat itong kilalanin bilang pangangatwiran mula sa mekanismo sa halip na mula sa napatunayang superiority.

Ang tibay ay nagiging isang mas malaking katanungan

Ang isang alalahaning ibinangon halos dalawang dekada na ang nakalilipas ay lumala sa halip na maresolba: ang tibay ng implant ay mas mahalaga habang tumataas ang life expectancy, at habang ang mga operasyong ito ay ginagawa sa mga mas bata at mas aktibong pasyente na gagamit nito nang mas matagal [4]. Ang isang implant na may katanggap-tanggap na performance sa loob ng sampung taon ay magkaibang usapin sa edad na 75 kumpara sa 55.

Sa praktikal na aspekto, ito ay isang dahilan upang maging malinaw kung ano ang nais mong makamit ng operasyon. Para sa paginhawa ng sakit, pagtatama ng deformity at pagpapabuti ng function sa isang kamay na may katamtamang mechanical demands, ito ay isang operasyong may sapat na suporta at mahabang rekord. Ngunit bilang isang matibay na reconstruction para sa mabigat na paggamit sa loob ng ilang dekada, hindi ito angkop.

Mga Sanggunian

[1] Herren DB. Balancing metacarpophalangeal joint arthroplasty in rheumatoid arthritis. J Hand Surg Eur Vol. 2026;51(6):778-84. https://doi.org/10.1177/17531934261430139

[2] Srnec JJ, Wagner ER, Rizzo M. Implant arthroplasty for proximal interphalangeal, metacarpophalangeal, and trapeziometacarpal joint degeneration. J Hand Surg Am. 2017;42(10):817-25. https://doi.org/10.1016/j.jhsa.2017.07.030

[3] Martin AS, Awan HM. Metacarpophalangeal arthroplasty for osteoarthritis. J Hand Surg Am. 2015;40(9):1871-2. https://doi.org/10.1016/j.jhsa.2015.05.019

[4] Goldfarb CA, Dovan TT. Rheumatoid arthritis: silicone metacarpophalangeal joint arthroplasty indications, technique, and outcomes. Hand Clin. 2006;22(2):177-82. https://doi.org/10.1016/j.hcl.2006.02.001

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

MCP joint arthroplasty was performed safely in the setting of acute complex open MCP joint trauma [1].
Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years [2].
Revision MCP arthroplasty has a relatively high rate of postoperative dislocations [2].
Dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years [3].
Treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation [4].
MCP joint arthroplasty is an effective treatment option from a patient-centered perspective, improving appearance, pain, and function [5].
Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief and correction of deformity [6].
Patient satisfaction with Silastic interposition arthroplasty of the MCPJ is high despite only modest improvements in the objective assessment of hand function [6].
The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in OA patients [8].
Periprosthetic joint infection is uncommon after MCP or PIP arthroplasties [9].
Patient expectations of MCP joint arthroplasty were uniformly high, with functional improvement being the greatest motivation for surgery [11].
Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty and facilitating realistic expectations [14].
Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction [24].
Implant arthroplasty of the PIP, MCP, and TMC joints has historically suffered from high rates of complications [24].
The evidence regarding MCP arthroplasty for OA consists of retrospective cohorts with small sample sizes and relatively short evaluations [26].

Anatomy & Pathophysiology

Joint Mechanics and Kinematics

The metacarpophalangeal joint allows hyperextension up to approximately 20° [17].
Radial and ulnar deviation at the metacarpophalangeal joint decreases with flexion due to the associated tightening of the collateral ligaments [17].
Volar and proximal translation of the proximal phalanx is observed on 4-dimensional computed tomography following silicone implant arthroplasty [48].

Bony and Ligamentous Anatomy

The metacarpophalangeal articulations serve as the keystones of the longitudinal arches of the hand [39].
The thick anterior glenoid capsules, known as volar plates, prevent hyperextension at the metacarpophalangeal joints [39].
The volar plates are interconnected by the transverse interglenoid ligament [39].
The stability of the metacarpophalangeal joints is essential to the support of both the longitudinal arch and the transverse metacarpal arch [39].
The deep transverse intermetacarpal ligament, also named the interglenoid ligament, ties together the anterior glenoid ligaments of the metacarpophalangeal articulations [39].
The lateral accessory ligaments, sagittal bands of the extensor apparatus, and the first annular segment of the flexor tendon pulley insert on the volar plate [39].

Muscular Anatomy

The deep head of each dorsal interosseous muscle forms a lateral tendon, or lateral band, at the level of the metacarpophalangeal joint [36].
The deep head of the dorsal interosseous muscles flexes and weakly abducts the proximal phalanx while extending the middle and distal phalanges [36].
Transverse fibers arch dorsally from each lateral band to join over the dorsum of the finger, flexing the proximal phalanx [36].
Oblique fibers from the lateral bands sweep over the distal third of the proximal phalanx to insert onto the lateral tubercles at the base of the middle phalanx [36].
The oblique fibers extend the middle phalanx at the proximal interphalangeal joint [36].
The lateral bands are joined by the lateral slips of the extensor tendon to form the conjoined lateral band [36].
The two conjoined lateral bands to each finger unite at the distal third of the middle phalanx to form the terminal tendon [36].
The terminal tendon inserts at the base of the distal phalanx to extend it [36].
The volar interossei form the ulnar lateral band of the index finger and the radial lateral band of the ring and little fingers [36].
The flexor digiti quinti brevis forms the ulnar lateral band of the little finger [36].

Pathophysiology

Rheumatoid arthritis is a chronic, progressive, systemic inflammatory disease that affects multiple organ systems, including the musculoskeletal system [17].
The inflammatory process in rheumatoid arthritis is triggered and perpetuated by a cascade of mediators that result in synovial proliferation, collagenous destruction of the cartilage and soft tissues, and bone resorption [17].
The metacarpophalangeal joint is the most common site of involvement in the rheumatoid hand [17].
The metacarpophalangeal and proximal interphalangeal joints of the hand are typically involved early in rheumatoid arthritis [17].

Classification

Silicone rubber implants are the most frequently used device for treatment of revised metacarpophalangeal arthroplasty [17].
The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in osteoarthritis patients [8].
Pyrocarbon implants were designed as a resurfacing implant for the MCP joint [28].
A radiographic classification system was modified to differentiate stable implant migration patterns (grade 2) from unstable patterns (grade 3) based on cortical breach status [28].
In a radiographic analysis of 37 pyrocarbon arthroplasties, 34 (92%) were determined to be stable at last follow-up [28].
Three (7%) pyrocarbon implants became unstable from migration, all involving grade 3 implant loosening [28].
Evidence of implant subsidence greater than 1 mm occurred in 6 (16%) of 37 pyrocarbon implants [28].
Postoperative ulnar deviation greater than 10° occurred in 8 (22%) fingers following pyrocarbon arthroplasty [28].
Implant fractures in silicone MCP arthroplasty are determined based on criteria including lucent lines, fragmentation, translation greater than one-half the diameter of the bone, and dislocation defined as proximodistal overlap more than one-half the width of the midportion of the implant [20].
Coronal plane deviation greater than 45° is an additional criterion for determining implant fracture or instability in silicone MCP arthroplasty [20].

Clinical Presentation

Indications and Etiology

Metacarpophalangeal joint arthroplasty is most often performed in patients with rheumatoid arthritis, although it is occasionally performed for joints affected by osteoarthritis [17].
Dorsal capsule interpositional arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ [3].
Metacarpophalangeal joint arthroplasty continues to play a central role in the management of the rheumatoid hand [15].

Patient Expectations and Motivation

Functional Outcomes and Range of Motion

Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief and correction of deformity, and patient satisfaction is high despite only modest improvements in the objective assessment of hand function [6].
Pain ratings and MCP arc of motion significantly improved following arthroplasty for noninflammatory arthritis [10].
Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction but has historically suffered from high rates of complications [24].
This study showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction in patients undergoing MCP arthroplasty for nonrheumatic arthritis [30].
Swanson arthroplasty frequently results in a range of flexion of the MP joint of the little finger that may be insufficient for its principal functions [19].

Complications and Complications Management

Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations [2].
The treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation [4].
Increasing MCP joint flexion range was associated with increased fractures of the implants in silicone metacarpophalangeal joint arthroplasty for patients with rheumatoid arthritis [7].
If squeaking is associated with pain and swelling, revision MCP joint arthroplasty is recommended to identify and correct the underlying cause, such as implant subsidence or an incongruous joint [53].
An articulating spacer allows movement of the joint and reduces the chance of immobilisation associated complications such as bone loss, joint stiffness, and soft tissue contracture in the management of infected MCPJ arthroplasties [13].

Investigations

A careful physical examination is essential to direct care and future testing if indicated [27].
Diagnostic tests such as imaging and serum laboratory studies are useful in determining pathology but can be expensive, time consuming, and often nonspecific [27].

Treatment

Indications and Patient Expectations

MCP joint arthroplasty is most often performed in patients with rheumatoid arthritis, though it is occasionally performed for osteoarthritis [17].
The MCP joint is the most common site of involvement in the rheumatoid hand [17].
MCP joint arthroplasty continues to play a central role in the management of the rheumatoid hand [15].
Given improvements in the medical management of rheumatoid disease, the indications for and long-term expectations of silicone metacarpophalangeal arthroplasty must be carefully examined [50].

Implant Types and Outcomes

Both NeuFlex and Swanson implant groups obtained satisfactory clinical improvement after MCP reconstruction of the hand [12].
Pain ratings and MCP arc of motion significantly improved following surface replacement arthroplasty in metacarpophalangeal joints affected by noninflammatory arthritis [10].
Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients undergoing pyrocarbon metacarpophalangeal joint arthroplasty for noninflammatory arthritis [31].
Silicone arthroplasty for nonrheumatic metacarpophalangeal joint arthritis showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction [30].
Follow-up studies show that MCP arthroplasty improves function and deformity and achieves nearly uniform patient satisfaction [17].

Alternative Techniques

Limited clinical follow-up in a perichondrium transplant group showed reasonably good, and in some cases excellent, results several decades after the surgery, especially at the MCP level [16].
Arthrodesis has been the gold standard in treating isolated end-stage MP arthritis, whether inflammatory or post-traumatic arthropathies [32].
Arthrodesis is able to provide effective pain relief as well as restore stability to the joint, even in the setting of severe arthritis [32].
The key to why MP fusion in the thumb is so successful lies in the relatively negligible loss of motion that results from MP fusion [32].
By fusing the MP joint between 20 and 40° of flexion, stress can be relieved from the CMC joint by minimizing the activity required at the CMC for thumb opposition [32].

Complications and Revision

Metallosis is a potential long-term complication of grommets in silicone MCP joint arthroplasty, and given the lack of documented benefit from grommets, the authors recommend against their use [52].
Static spacers with consequent immobilisation can lead to bone loss, joint stiffness and soft tissue contracture, often causing significant complications at reimplantation [13].
An articulating spacer allows movement of the joint and reduces the chance of immobilisation associated complications [13].
An articulated spacer technique can be considered as an option to maintain motion while treating infected MCPJ arthroplasties and the co-morbidity resulting from immobilisation of the whole hand [13].

Specific Clinical Scenarios

Complications

Dislocation and Instability

Revision MCP arthroplasty is associated with a relatively high rate of postoperative dislocations [2].
Treatment of acute MCP joint arthroplasty dislocation with revision to a silicone implant appears to hold the most promise in achieving a stable MCP joint [4].
In a cohort of 37 cases, acute prosthetic dislocation was managed with revision surgery [4].

Implant Fracture and Failure

One in five patients undergoing revision MCP arthroplasty required a revision procedure at 5 years [2].
Increasing MCP joint flexion range was associated with increased fractures of silicone implants in patients with rheumatoid arthritis [7].
In a longitudinal analysis of 325 cases, implant fractures were determined based on criteria including lucent lines, fragmentation, translation greater than one-half the diameter of the bone, and dislocation defined as proximodistal overlap more than one-half the width of the midportion of the implant [20].
In a study of 40 silicone implants for MCP osteoarthritis, radiographs demonstrated fractured implants in 5 of 40 (12.5%) implants, although none of these patients had clinical instability, pain, or deterioration in range of motion [33].
For the Neuflex silicone implant, survivorship at 7 years was 88% when revision was the end point, but dropped to 68% when implant fracture was the end point [56].
In a study of pyrocarbon arthroplasty for rheumatoid arthritis, complication and overall reoperation rates were high, with 1 in 10 patients undergoing revision within 5 years postoperatively [57].
Patients with greater hand function preoperatively may be at higher risk of revision surgery after silicone MCP arthroplasty for inflammatory arthritis [18].

Infection

Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [9].
Management of infected MCP joint replacements can involve removing the prosthesis and inserting gentamycin-loaded bone cement balls for 3 weeks before a final exchange operation [13].
Static spacers used in MCPJ infection management can lead to bone loss, joint stiffness, and soft tissue contracture, often causing significant complications at reimplantation [13].
An articulating spacer allows movement of the joint and reduces the chance of immobilization-associated complications compared to static spacers [13].

Other Complications

Intraoperative periprosthetic fractures are associated with metacarpophalangeal joint arthroplasty [21].
Swanson arthroplasty frequently results in a range of flexion of the MCP joint of the little finger that may be insufficient for its principal functions [19].
In a study of pyrocarbon arthroplasty for osteoarthritis, postoperative ulnar deviation greater than 10° occurred in 8 (22%) fingers [28].
In a study of pyrocarbon arthroplasty for osteoarthritis, 3 (7%) implants became unstable from migration, all with grade 3 implant loosening [28].
Evidence of implant subsidence greater than 1 mm occurred in 6 (16%) of 37 pyrocarbon implants, but no implants studied at more than 1 year after surgery demonstrated progressive subsidence resulting in implant instability [28].
Implant arthroplasty of the MCP joint has historically suffered from high rates of complications [24].

Recovery

Functional Outcomes and Patient Satisfaction

MCP joint arthroplasty improves appearance, pain, and function from a patient-centered perspective [5].
Silastic interposition arthroplasty of the MCPJ is reliable for pain relief and correction of deformity [6].
Patient satisfaction is high following Silastic interposition arthroplasty despite only modest improvements in the objective assessment of hand function [6].
The HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint demonstrates satisfactory short- to mid-term outcomes with considerable improvements in pain relief and joint mobility [59].

Complications and Revision

Patient Expectations and Indications

Specialized Scenarios

Key Evidence

[L4] MCP joint arthroplasty was performed safely in the setting of acute complex open MCP joint trauma. [1] (10.1016/j.jhsa.2015.09.012)
[L4] Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations. [2] (10.5435/jaaos-d-17-00042)
[L4] This technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years. [3] (10.1177/1558944720911215)
[L4] The treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation. [4] (10.1016/j.jhsa.2017.10.001)
[L4] MCP joint arthroplasty is an effective treatment option from a patient-centered perspective, improving appearance, pain, and function. [5] (10.1016/j.hcl.2006.02.001)
[L4] Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief and correction of deformity, and patient satisfaction is high despite only modest improvements in the objective assessment of hand function. [6] (10.1054/jhsb.2000.0402)
[L4] Increasing MCP joint flexion range was associated with increased fractures of the implants. [7] (10.1016/j.jhsa.2020.09.002)
[L5] The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in OA patients. [8] (10.1016/j.jhsa.2012.11.025)
[L4] PJI is uncommon after MCP or PIP arthroplasties. [9] (10.1016/j.jhsa.2024.12.008)
[L4] Pain ratings and MCP arc of motion significantly improved following arthroplasty. [10] (10.1177/15589447211028917)
[L1] Patient expectations of MCP joint arthroplasty were uniformly high, with functional improvement being the greatest motivation for surgery. [11] (10.1016/j.jhsa.2011.02.002)
[L1] Both implant groups obtained satisfactory clinical improvement after MCP reconstruction of the hand. [12] (10.1016/j.jhsa.2009.09.020)
[L5] [13] (10.1177/17531934251323067)
[L4] Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty and facilitating realistic expectations. [14] (10.1002/msc.1061)
[L5] Metacarpophalangeal joint arthroplasty continues to play a central role in the management of the rheumatoid hand. [15] (10.1177/17531934261430139)
[L3] [16] (10.1186/s12891-020-03687-3)
[L5] [17] (10.5435/00124635-200305000-00005)
[L3] Patients with greater hand function preoperatively may be at higher risk of revision surgery. [18] (10.1177/1558944719831236)
[L4] Our experience with this cohort, a review of published literature, and a survey of international experts suggest that Swanson arthroplasty frequently results in a range of flexion of the MP joint of the little finger that may be insufficient for its principal functions. [19] (10.1007/s11552-007-9051-5)
[L4] [20] (10.1177/1753193418778461)
[L3] [21] (10.1016/j.jhsa.2014.12.038)
[L4] Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction but has historically suffered from high rates of complications. [24] (10.1016/j.jhsa.2017.07.030)
[L4] The evidence regarding MCP arthroplasty for OA consists of retrospective cohorts with small sample sizes and relatively short evaluations. [26] (10.1016/j.jhsa.2015.05.019)
[L4] [28] (10.1016/j.jhsa.2022.08.013)
[L3] This study showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction in patients undergoing MCP arthroplasty for nonrheumatic arthritis. [30] (10.1016/j.jhsa.2013.09.016)
[L4] Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients. [31] (10.1016/j.jhsa.2015.06.104)
[L5] [32] (10.1016/j.hcl.2006.02.010)
[L4] [33] (10.1016/j.jhsa.2017.10.010)
[L4] Volar and proximal translation of the proximal phalange was observed on 4-dimensional computed tomography. [48] (10.1016/j.jhsa.2021.10.001)
[L4] Given these findings, the indications for and long-term expectations of silicone metacarpophalangeal arthroplasty must be carefully examined in light of the improvements in the medical management of rheumatoid disease. [50] (10.2106/00004623-200310000-00001)
[Case_report] Metallosis is a potential long-term complication of grommets in silicone MCP joint arthroplasty, and given the lack of documented benefit from grommets, the authors recommend against their use. [52] (10.1007/s11552-012-9401-9)
[L5] If squeaking is associated with pain and swelling, revision MCP joint arthroplasty is recommended to identify and correct the underlying cause, such as implant subsidence or an incongruous joint. [53] (10.1016/j.jhsg.2022.10.002)
[L4] [56] (10.1177/1753193408094437)
[L4] Complication and overall reoperation rates were high, while 1 in 10 undergo revision within 5 years postoperatively. [57] (10.1177/15589447211063577)
[L4] The HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint demonstrates satisfactory short- to mid-term outcomes, with considerable improvements in pain relief and joint mobility. [59] (10.1016/j.jhsg.2025.100804)

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