Mcp knuckle replacement yay or nay?

Katiedaisy · 1. Dec 2015, 15:38

Hi all. In a dilemma and after some advice please. If you had no pain in a joint, but that joint didn't move, would you risk surgery to possibly increase movements?
I have RA in all my joints most noticeably in my right hand (I'm right handed) my fingers are stuck straight, but bend 90 degree at the base knuckles so my hand is stuck in an "l" shape. I can still grip by pushing things into the gap between my palm and fingers and using my thumb a lot. I can work, drive etc although I do struggle a bit and rely on my partner at home for food prep, opening things etc. weirdly, I am in little pain from my hand. I have had three different opinions from various orthopaedic surgeons. One four years ago said operate and replace all mcp joints, a second said don't as ur in no pain and can still function and a third more recently said operate as it's slowly getting worse and an operation can only make it better as movement wise it can't get much worse! Replacing the joints would straighten my hand and may give me some slight movement in my other finger joints although he can't be certain.
My dilemma is whether to go for surgery or not. I know most joint replacement is done to manage pain.if I have no movement in my hand but also no pain - is that better than risking surgery? Could replacement joints actually give me pain? I'd rather have what I have now than a hand that can move slightly but that hurts! I'm also only 36 years old and I know the joints don't last forever.
Advice please? Has anyone out there had surgery for a reason other than pain? What were the results? Or have any of you had mcp joints replaced and how did it go?

TrishaW · 1. Dec 2015, 19:12

Hi Katiedaisy,

I can only give my own opinion here, which may not be right for you, but having had painful fingers for years which affect everything I do, I wouldn't take any risk having surgery that may cause pain.

I guess the surgeons will say it won't cause pain, and it probably shouldn't once it's healed. However i had a toe fusion a year ago and am one of the 5% with delayed fusion and increased pain and also got complex regional pain syndrome. This was just unlucky (I had a fab foot surgeon) but I really regret having the surgery. I never thought i'd be in the 'rare' statistics.

As you are only 36 I would imagine that surgical procedures will develop and improve in the next 10 years so if you waited there may be something better for you in the future.

There is no necessity to have this done now if you are in doubt...you can delay until you feel your stiff finger is making life intollerable and any risk is worth taking.

If you find your finger is making things unbearable then you will think differently about this and not be as hesitant.

Anyway this is just my personal view, and i'm sure others will disagree.

At the end of the day there is no rush and it's your decision...surgeons are good at reassuring you that they can fix things but it's your hand!

good luck,

Trisha xxx

stickywicket · 2. Dec 2015, 04:33

I have several immobile but relatively painless joints in my hands and feet. My RA started in my hands over 50 years ago. Now I get very little pain there but, in the absence of DMARDS when first needed, my finger joints are now all over the place. Like you, though, my grip(s) are with my thumb pressed across my palm. I did see a hand specialist about 25 years ago but he said that, since I had a grip and little pain he'd advise against it. But bear in mind that was about 25 years ago.

Although I'm sure surgery will have improved in the interim I wouldn't think of having it now as I consider I have a fine balance there – tip it one way or the other and I have a lot to lose. You, though, are in a different situation. You have already seen three surgeons which suggests that this is something which is constantly on your mind. I wonder why, as you say you were told the op would 'straighten my hand and may give me some slight movement in my other finger joints although he can't be certain. ' A straight hand would look better but would it be as useful as what you have now? What would happen with your grip?

Replacement joints don't last forever though I currently have a 34 yr old TKR. I've no idea how long hand joints are designed to last but that's something a surgeon should be able to answer.

Maybe, for your own peace of mind, you need to make a decision and stick with it. Either go for the op (maybe in your less dominant hand first) or decide definitely not to for at least a certain number of years. That way you won't be constantly wondering about it.

theresak · 2. Dec 2015, 10:10

Hi Katiedaisy,

Sorry I can`t offer any advice - just wanted to wish you luck as you try to come to a decision.

daffy2 · 2. Dec 2015, 12:16

Has the third opinion come with any indication as to whether waiting is an option? Has the surgeon had other patients in this situation, and if so what has the outcome been?
It's a real dilemma for you, without pain as a deciding factor and with 3 differing opinions from the experts.Weighing up the devil you know against the possibility of banishing the devil at least partially if the operation is successful must seem quite daunting. Either decision is likely to bring 'what if's' so Sticky's suggestion to make a decision one way or the other makes sense.

ttmc · 3. Dec 2015, 02:32

Hi Katiedaisy,

If I was discussing joint replacement surgery, these are the first things I would want to get answers to:

- What is the procedure? How will it help?

- What is the best I could expect e.g., complete cure - Are there any side effects/risks - Could this treatment limit choices of treatment further down the line (e.g, can you get a second joint replacement or other procedures etc) - How long to wait for surgery, where it could be done and by who - What sort of anaesthetic, and how long does the operation take - How long in hospital after operation
- How long do these joint replacements last? What is best and worst case?
- How long it would take to recover after surgery?
- What will recovery involve - physio etc, and over how long?
- How long would it take to get back to work / other activity?
- What are the technical terms for the procedure(s)?
- How many times have you performed the procedure?
- Your success rate for procedure?
- What is the success rate generally?
- In what percentage of patients does the procedure make things worse?
- In cases where it does go wrong, what are the risks and what can be done to rectify it?
- In cases where it does go wrong, what support is available and from who?

I can see you've had an option from a number of surgeons, so you could ask any questions you have of all of them in writing, which can help focus the mind a bit

You have probably already have covered all of these questions with them, but just wanted to chip in with what I'd personally find helpful.

I think it's really good asking for other people's experiences, as it can be hard to know where to start with things like this!

At the end of the day, all you can do is get as much information as possible and base your decision on the level of risk you're willing to accept vs benefits the procedure might bring.

PetiteN · 3. Dec 2015, 18:35

Hi there,

I can't really add anything to the advice that everyone else has given on here, however I have had MCP joint replacement surgery on my right hand, three years ago, (aged 30) and it's been the most successful joint surgery I've had :-)

I didn't have tons of pain in that finger, some, but the mobility was the main issue for me.
The surgery put my finger back into a much more normal position and the joint function was soo much better afterwards.
I'm right handed and three years on it's great.

There was alot of hand physio required for about eight weeks after.

For me it was a huge success, and I'd like to get other finger joints done in the future, I've only had that one done so far.

But obviously for you it depends how well you feel you are managing, and weighing up the pros and cons.

N x

Mcp knuckle replacement yay or nay?

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