Wednesday, 23 March 2016

Arthroplasty of the MCP Joints (New Knuckles)

If you had rheumatoid arthritis (RA) diagnosed in the 80's, or if your RA has been very aggressive, you might know the meaning of the title. Otherwise it sounds like medical jargon that you need to go home and google. As an involved patient I always want to know what medical language means.

The story starts with a surgeon who must have been tired of describing procedures to patients. He put up a hand to stop my questions at the first visit, when he laid out a plan that ultimately involved straightening my fingers. 

However when he said this process would take 3 operations that was the end of the road.  With a full time job I could not afford the time to have that much surgery. His plan was to fuse both wrists and then straighten the fingers - I found out on my own that this is the best way to proceed. His explanation of his reasoning was not 'patient-friendly.'

Once I retired I was able to take the time to start with surgeries. The results of operation #1 were very successful, so after a year I went back to have a second wrist fusion. With both wrists immobilized and with the new found ability to turn my hand palm up, I was ready for the grand finale and just in time, because my fingers were getting worse and using them was getting more difficult. 

How much worse? This much

But - when I went back to the surgeon, he said "Too bad you didn't have this done when I suggested it because I'm retiring." Not the most sympathetic doctor, but also not the only one in the city.

Now it's done and I have new knuckles. Despite telling Debby's story of success with this I had doubts, especially when a trusted friend told me that doctors in her city were no longer willing to do this procedure.

However, with a US friend who has RA finding that three of her fingers were so badly displaced that she has lost hand function I carried on.

This is a picture of what I believe my knuckles look like on X-ray now. I don't have an x-ray of my own since the doctor did not do one. Now I have an implant in all 4 of my knuckles (MCP joints).

Silastic implants

You might wonder whether the operation was a success.

It was done ten weeks ago. I started in a cast, then graduated to various splints. Every week the Occupational Therapist would adjust both the night splint and the one I wore during the day. 

The day splint became smaller as I was able to gradually start moving my joints more and to start on a gradually increasing exercise program. I felt that the splinting and the exercise program were as important to the operation's success as the surgery.  

Now I am able to write again and to type faster. The occupational therapist who is still helping me advised me to wear a small splint to keep my fingers straight during the day, and a splint from fingertips to forearm at night. In retrospect I think that the surgery was only half of the procedure - occupational therapy and dynamic splinting was vital for the final success.

Here's the finished product - my hand today! Better than before.

It's a perfect example of the teamwork between professionals that is required for the best results to patients.

Perfection  is impossible, but I expect to be able to use my hand for a lot more years now, and better long-term function was the main reason I had the surgery.


  1. I have never heard of this surgery and I can tell you are happy with the result. I think your hands where beautiful before the surgery and after.

  2. I think your surgeon has done a fabulous job Annette, what a difference that must be making to your everyday life & ability to use your hand much more normally.

  3. Hi Annette - that is a remarkable job - and I'm so glad that it's given you a new lease on life. Thank you for sharing so openly on your blog. I have a yoga student who has done the wrist fusions due to autoimmune arthritis, and it's very helpful to understand what is involved. I am interested, if you don't mind sharing, if there are any exercises you do for your wrists and hands that help keep them strong and flexible, when you have time of course. All the best, Jane

    1. Hi Jane,
      The only hand exercises I have done were given to me by The Arthritis Society and don't seem to have changed much over the years. Of course for me no wrist exercise is possible anymore. :)
      I am gradually trying to get back to my arthro-pilates - you really notice a difference if you revert to doing no exercise at all.

  4. You are brave. Glad for the good news that you have active use of your hands. When I feel arthritis in my right hand I am able to use hot water to relieve the symptoms. I hope the black guy who crippled my right hand stealing from me (maybe 22 years ago) was eventually caught by the police who can and will use force to uphold the law. Tell me if you need a hand. I know Don is handy and you both have helped me greatly. Happy Easter 2016. Terry.

    1. Thanks for the kind offer Terry. I know what you mean about the hot water - it sure does feel good.

  5. Beautiful. I was nearly in tears to see those photos. They really took me back.

    I had this surgery on both hands in my 30s while by sons were 2 and 7. I never regretted it.

    Now (at 61)I want my feet done and have been waiting 6 years for a surgery date.

  6. This surgery was worth having done; it is much easier to type now. My knuckles are still stiff but that continues to improve as time goes by. Joanne, it's a shame that you have been waiting 6 years for a foot operation. I plan to have one more surgery and hope it will be the last. I have been putting it off for 10 years in part by wearing a brae called an AFO (ankle-foot orthotic) and some cortisone injections.
    'm glad your hand operations were so successful.

  7. hi, im so glad i found this going to have the joint replacement surgery on my knuckles in may....i have very severe deformity and im only a little scared mixed with relief and interested in seeing the scar left on the knuckles after the surgery and to see your hand pictures now Anet after all this time .....would you be able to give me an update?

  8. My fingers have 50% less ulnar deviation now - that is based on measurements taken by an occupational therapist before and after.

    I'll try to add another picture. Now the scar is less visible than it was in the last picture on the blog post. The function is good, though the left hand is still the strongest. I really apprecated the OT's encouragement and exercises to help get the best function.

    I can type with all of my fingers so since the surgery my speed has gone up.

    1. thanks Anet for replying, yes would love to see a new photo of your hand now, i think my ulnar deviation is a lot worse than yours was, so are you saying that the operation doesnt straighten the hand completely, or has the RA progrssed the ulnar deviation since the operation?...just wondered cos you said it was 50% less rather than 100% less....interesting that your left hand is still the you still cant carry or hold things with a little weight even after having joints replaced?