Introduction

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.

Post-operative care
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.

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.

 Complications