Arthritis in the hands: when to consider surgery
Hand arthritis is treated conservatively first. This sets out what non-surgical management involves, the findings that make an operation reasonable, and what each of the surgical options actually does.
Arthritis in the hand is not only a matter of discomfort. It costs grip, dexterity and, eventually, the ability to do ordinary things — turning a key, holding a cup, fastening a button. Deciding when to operate is a question of function lost, not of imaging alone.
How it presents
Stiffness in the morning, swelling around the affected joints, tenderness and a reducing range of movement are the usual first complaints. As the disease advances, visible deformity or firm nodules may appear at the joint.
The distinction between osteoarthritis and rheumatoid arthritis matters, because the two damage the hand differently. Osteoarthritis is wear of the articular cartilage. Rheumatoid arthritis is an immune process directed at the joint lining, and it also attacks tendons.
What is tried first
Surgery is not the first step. Splinting to support the wrist or the affected fingers during activity, corticosteroid injection to settle inflammation, hand therapy and changes to how a task is performed will often hold the situation for a considerable time.
What makes surgery reasonable
- Pain that persists despite conservative treatment and interferes with sleep, work or basic tasks
- Loss of joint function affecting grip and finger movement
- Visible deformity of the hand or wrist that is progressing
- Instability or weakness at the joint leading to repeated injury
- No meaningful response to hand therapy and injection
The operations
Joint fusion (arthrodesis) unites the two bones of the affected joint. It removes movement at that joint, and with it the pain, and gives a stable platform. It is used for severe arthritis at the base of the thumb and for the unstable wrist.
Joint replacement (arthroplasty) removes the damaged cartilage and bone and substitutes an implant, preserving movement. It is most often used at the knuckle joints and at the thumb base.
Tendon reconstruction or transfer is used where arthritis has damaged the tendons that move the hand. It is particularly relevant in rheumatoid arthritis, where tendon rupture occurs.
Nerve decompression addresses nerves compressed by arthritic swelling — carpal tunnel release being the common example, where the complaint is numbness or tingling rather than pain.
Arthroscopic debridement allows inflamed tissue to be cleared and bone surfaces smoothed through small incisions in earlier disease, with a shorter recovery than open surgery.
Recovery
Recovery depends on which operation is performed. Most involve a period of immobilisation in a splint or cast, followed by hand therapy directed first at range of movement, then at strength and dexterity. Light activity typically resumes in the region of six to eight weeks; the full picture takes three to six months.
Afterwards
Results are maintained by avoiding repetitive strain, using tools that reduce load on the joints, keeping up a daily stretching routine and attending follow-up. A hand therapist will work through the adaptations specific to your work and household tasks.
The procedure this relates to
Surgery for arthritic joints of the hand and wrist, ranging from joint fusion to replacement or reconstruction, with the aim of reducing pain while preserving as much function as possible.
Before you act on this
Everything here is general. What applies to you depends on your anatomy, your history and what you are trying to achieve, and none of that can be assessed from a page. If a question here is yours, bring it to a consultation.