Finger joint arthrosis

If the cartilage and bone changes are not yet so severe, the symptoms can be treated with conservative - non-surgical - measures. These include cold protection, the use of cartilage protectors, possibly painkiller ointments or, better still, sprays and, if necessary, cortisone injections. If the pain is not sufficiently alleviated with these measures, surgical treatment must be discussed.

If a massive restriction of mobility, i.e. stiffening, has already occurred and the finger is significantly bent, the only option is to remove the destroyed joint and stabilise it, usually with a screw. With this type of stiffening, pain relief can often only be reliably achieved at the expense of a small amount of residual mobility. However, the finger becomes approx. 3 millimetres shorter. This surgical procedure is chosen exclusively for the treatment of pain. If, on the other hand, the gnarled appearance of the arthrosis finger is also aesthetically unpleasant, the worn joint can be replaced with a prosthesis earlier in the course of the disease if the function and correct axis are present. The insertion of an artificial joint prevents painful bone rubbing and mobility can be maintained. To do this, the extensor tendon above the joint must be detached from the bone, all of the interfering bone growths of the osteoarthritic joint and the damaged joint surfaces can then be removed and the prosthesis inserted. This is not anchored or cemented into the bone. Instead, it serves as a movable placeholder to prevent bone rubbing against bone. In most cases, a silicone hinge prosthesis is used. There is already decades of experience with this implant.

Fig. 1 and 2: Advanced finger end joint arthrosis (Heberden's arthrosis).
Figs. 3 and 4: After prosthetic treatment This arthrosis is ideally suited for treatment with a prosthesis, as the finger axis is preserved, i.e. no curvature has yet occurred.

There are also artificial joints made of modern materials such as pyrocarbon. However, there is a lack of long-term clinical results for prostheses made of such materials. The procedure takes around 45 minutes per finger joint and can be performed with anaesthesia of the finger only if desired. It is also possible to operate on several fingers at the same time. If necessary, any joint cysts are removed to restore the finger joint to a slim condition. If the pressure of such a cyst on the nail growth zone is removed, even the furrow-like change grows out again. However, the fingernail needs up to six months to fully recover. It is important that the reattached extensor tendon over the artificial joint heals completely, which experience has shown takes six weeks. During this time, a small finger splint is worn, which only immobilises the operated joint. This does not significantly impair the function of the hand.

As long as a painful osteoarthritic joint is functioning well, it is difficult to advise a pain-relieving fusion. In this situation, all conservative measures are tried until the extent of the pain forces surgical action. However, if the mobility of the joint can be maintained by means of a prosthesis replacement, this period of suffering can be shortened and relief is possible even in the earlier stages of osteoarthritis. This avoids the development of disfiguring deformities of the fingers. In addition, the length of the finger is retained with prosthetic replacement of the end joint, and the shortening that occurs with fusion - and therefore a certain clumsy appearance - is eliminated. In most cases, the wounds can simply be closed with a special wound plaster, resulting in almost invisible scars. In principle, the new joint can be moved immediately. However, the soft tissues around the prosthesis must heal first, especially the extensor tendon, which is cut and then reattached. If the post-operative immobilisation is insufficient, an extension deficit remains, i.e. the finger cannot be fully straightened. However, the duration of treatment does not differ significantly from that of a fusion. As with all joint prostheses, the bone around the artificial joint can dissolve and the prosthesis can loosen or break. If such a complication occurs, it is still possible to switch from a prosthesis to a fusion. However, if someone has to carry out heavy manual activities with regular forceful gripping of the hands, stabilisation by fusion is recommended at the expense of mobility.

To summarise, it can be said that prosthetic treatment of the arthrosis-damaged finger end joint has a clear advantage over joint fusion in earlier stages of the disease. Mobility can be maintained with reliable pain relief and the finger regains a normal appearance. This means that the patient does not have to endure suffering until the pain is relieved by the stiffening, but can retain finger function and also fulfil aesthetic requirements.