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Medical Forum / Diseases and Disorders / Arthritis / December 2004Finger joint replacement surgery
Hi all, Back in October sometime, I posted about having two of my PIP joints replaced and was asking if anyone had had any experiences with finger joint replacements. I didn't get a lot of responses since it sounds like it's not a super-common surgery, so I thought I'd post a follow-up here with my experience to date so that anyone like me who's searching for info in the future has at least one person's story to go on. I had two DIP joints replaced (ring and pinky fingers, left hand), and one has gone great, but the other... not so much. My pinky finger is doing really well. Even though the DIP joint has auto-fused and it is still pretty useless, the PIP joint that was replaced has a far greater ability to flex -- 90 degrees or so now. It doesn't hurt much anymore, and wouldn't hurt at all if I hadn't had a second surgery (more on that later). Right now it's flexing well but not extending well, but apparently that's very normal at this stage of recovery so I'm wearing an extension splint to help it along. I'm really happy with the way it has gone so far... never thought that finger would move again at all! My ring finger has been a real problem. At first it seemed great -- I was able to get really good range of motion, the pain was so-so, etc. But it started hurting more -- not excruciatingly, but more -- and so about a month after the first surgery, we x-rayed it just to make sure all was well, and lo and behold, it was dislocated really badly. My surgeon and occupational therapist were both shocked at how it looked considering how much I was able to move it and how comparatively little I had complained about pain. Both said they'd never seen anything like it. Anyway, the surgeon did another surgery to re-locate the implant. This time he bound it really tightly with the ligaments so it was stiffer but would hopefully stay in place properly. No such luck. Yesterday we x-rayed it (two weeks post-surgery) and it is out of joint again. Tonight I'm just waiting to hear what he will recommend next. He was going to consult with a colleague of his today and read some of the literature and try to decide the best course of action. Obviously it means another surgery, but whether that will involve a totally new implant or what, I don't know. I'd have to say my experiences with PIP joint replacement are a pretty mixed bag. I'm thrilled about the small finger, but this ring finger problem is pretty distressing. The surgeon said we still have a good chance of improving range of motion a lot when we get the right "solution" for that finger; so maybe it will still end well. And I know that my experience is unusual, based on the surgeon's and the occupational therapist's reaction to the situation, and also because the surgeon told me right after my first surgery that I have incredibly tiny bones which made it a much harder task to seat the implants properly, so someone with larger bones would likely have more success than I did. I just hope that surgery #3 is THE successful one, because I'm getting married in April and I NEED that ring finger. ;-) Tracy Tracy, whatever you and the doctor decide you need to do next, I pray it will work perfectly and that ring finger will be just right for the wedding. Gwen > Hi all, > [quoted text clipped - 56 lines] > > Tracy and lo and behold, it was dislocated really badly. My >surgeon and occupational therapist were both shocked at how it looked >considering how much I was able to move it and how comparatively little >I had complained about pain. Both said they'd never seen anything like >it. Anyway, the surgeon did another surgery to re-locate the implant. >This time he bound it really tightly with the ligaments so it was >stiffer but would hopefully stay in place properly. No such luck. >Yesterday we x-rayed it (two weeks post-surgery) and it is out of joint >again. >And I know >that my experience is unusual, based on the surgeon's and the >occupational therapist's reaction to the situation< Tracy, I'm not at all sure that your experience is all that unusual, based on what my hand surgeon has told me. I trust this man implicitly and his credentials are impecable, including the fact that he teaches hand surgery for Mayo Clinic. He refuses to do joint replacements on my finger joints for exactly the reason you are describing. He tells me that the prostheses for finger joint work really well if one is sedentery, but if a person is active at all, the prosthetics generally dislocate within a very short period of time. It's pretty demoralizing, but apparently at this point, joint fusions are pretty much the only way to ensure a pain free finger. Anne AAC/AAF/AFBV62.0844.AZ http://www.tckworld.com/opfoot > He tells me that the prostheses for finger joint work > really well if one is sedentery, but if a person is active at all, > the prosthetics generally dislocate within a very short period of > time. I think the thing that perplexed my surgeon and occupational therapist, the most though, was that I hadn't reached any kind of point of actively using the joint (apart from gentle OT exercises) either time that it dislocated, and was still wearing full splints, etc. at the time; and yet it somehow slid right out of place anyway. My surgeon even contacted the manufacturer of my implants and asked them about my case, and they said they'd never heard anything like it before. I think probably the implants do have a tendency to dislocate once you start using them more, but when you're still in those early, splinting and recovery stages, it seems pretty odd. > It's pretty demoralizing, but apparently at this point, joint > fusions are pretty much the only way to ensure a pain free finger. I have a very, very good but younger and, I think, less conservative surgeon (very highly regarded, though); and when I told him that my main goal was to be able to play the piano again he definitely felt that we had other options besides joint fusion. And for one of the fingers, it seems to have worked. But... I know that a more conservative approach would've been to fuse the joint, and I could've avoided a lot of this frustration. It's just that I wasn't prepared for that yet -- mentally, I mean. I still wanted to try whatever options were available to me to restore some functionality. I don't regret the decision to try -- for ME, in MY case where piano is so important to me -- but I certainly do agree that if it's solely a pain issue, the best and safest option will be a fusion. And that's part of why I wanted to post the details of my situation here: so that others have more information to make their decisions about similar surgeries wisely, depending on whether it's primarily a pain issue they want to address or a functionality one... and if it's the latter, to know the risks. Unfortunately, at this point in my case we're caught between a rock and a hard place, because even straightforward fusion isn't possible since I have no joint "ends" anymore, so we have to keep trying for an implant solution that will work. It appears that my surgeon and some colleagues he discussed my case with have decided that a single-piece silicone implant is the best bet, since it can't possibly dislocate and the tendons and ligaments in that finger haven't got the ability to hold the two-piece pyrocarbon joint together. However, silicone implants aren't a great choice for someone younger and someone who hopes to actively use the joint, and they have higher incidences of breakage, etc.; so it's not going to be as successful an option for me, but it will have to do at this point. I just pray this one works. Tracy >I have a very, very good but younger and, I think, less conservative >surgeon (very highly regarded, though); and when I told him that my >main goal was to be able to play the piano again he definitely felt >that we had other options besides joint fusion.< What options did he suggest other than a) finger joint replacement and b) joint fusion? >But... I know that a more >conservative approach would've been to fuse the joint, and I could've >avoided a lot of this frustration. It's just that I wasn't prepared for >that yet -- mentally, I mean. < That's exactly the reason I haven't done anything about it yet. I just can't bring myself to have the joints fused because if I do, that's it and I'm done. I keep hoping a more reliable prosthesis will be developed I guess. >-- but I certainly do agree that if it's solely a pain issue, the best >and safest option will be a fusion.< I wish it was solely a pain issue for me. Pain and continued deterioration are factors, of course, but I am an avid gardener and needlepointer and I am losing fine motor skills, particularly in my right hand, because I can no longer bend my index and middle finger. >And that's part of why I wanted to post the details of my situation >here: so that others have more information to make their decisions >about similar surgeries wisely, depending on whether it's primarily a >pain issue they want to address or a functionality one... and if it's >the latter, to know the risks.< I'm glad you did, although I was aware of the risks, I hadn't really talked to anyone who had actually had this done and what the results were. >Unfortunately, at this point in my case we're caught between a rock and >a hard place, because even straightforward fusion isn't possible since >I have no joint "ends" anymore, so we have to keep trying for an >implant solution that will work.< I tried to talk my surgeon into doing one joint on my left hand to see what would happen and he told me the same thing, that if we do it and it fails, as he is relatively sure it will, them I'm basically screwed if you will excuse the language, as then we won't be able to fuse it. I truly hope this works for you Tracy. Please keep in touch and let me know. Anne AAC/AAF/AFBV62.0844.AZ http://www.tckworld.com/opfoot Hi Anne, > > when I told him that my > > main goal was to be able to play the piano again he definitely felt > > >that we had other options besides joint fusion.< > > What options did he suggest other than a) finger joint replacement > and b) joint fusion? Sorry, I didn't word that very well. Those were the only options presented, except that with the finger joint replacement option, he gave me a few different possibilities in terms of the actual implant used -- pros and cons to the silicone vs. the PryoCarbon, etc. > That's exactly the reason I haven't done anything about it yet. I > just can't bring myself to have the joints fused because if I do, > that's it and I'm done. I keep hoping a more reliable prosthesis > will be developed I guess. I can sure understand that. It's one of those things about this disease that you can never prepare yourself for: the "letting go" of a damaged/destroyed joint and all of the consequences therein is a much, much harder task than people realize. Yes, it's "just a finger" to them, or whatever, but to us? It's a lot more than that. Yeah, I could've lived all right with a fused joint, but that's not the point. A fused joint *would* have prevented me from doing some of the things that bring me joy, and that's what people don't always see. Some people do, but not everyone gets it -- especially when it is "just a finger". > I wish it was solely a pain issue for me. Pain and continued > deterioration are factors, of course, but I am an avid gardener and > needlepointer and I am losing fine motor skills, particularly in my > right hand, because I can no longer bend my index and middle finger. Right, you sound like you're in the exact same position as I was/am: the pain issue is really secondary, it's more about the activities you lose out on, the things that bring you joy. For me, it's piano and cross-stitch, and the idea of giving up two of the things I love so much (*especially* piano) is really painful. Forget the physical pain of it... that's a deep emotional wound there! > I truly hope this works for you Tracy. Please keep in touch and let > me know. Will do. I scheduled my next surgery, to get the PyroCarbon implant removed and the silicone one put in, for January 14th. My ring finger will remain dislocated until that time, but if I keep it fairly still it doesn't hurt too much, and my other option was to have surgery on Christmas Eve, and I really didn't want that! So anyway, sometime in January/February I will post another update and let you know how it went. Tracy That is the kind of replacement that I have in all my fingers which have them and my right wrist as well. Mine are all Swanson implant [silicone]. found this picture -- see the sketch on the right. KJ alert -- I have no idea what the photo to the right of the sketch is but is looks like forks stuck into an open wound on feet. If I were you, I wouldn't look. rofl http://tinyurl.com/5bdlc I have had one of these implants turn itself around 90 degrees but not affecting the fingers use. That one finger is also the one that has decided to let the tendon draw the finger so it will not stay flat but that has nothing to do with the implant. Ask your doctor if he will do liposuction on what is left of the sawed of finger fat and skin. All that extra skin and fat has to go somewhere so each finger with a replacement looks like it is swollen at the base because of the chubby problem due to the excess. My doctor said I was the first and only person that asked him to do that. hehehe :) Thank goodness he likes me. He, BTW, did not do liposuction which is why I can tease him about it. Hope whatever you do next will work. I am also surprised that fusion can not be done now as my doctor always left that open as an option for the future. Probably just the kind of surgery you have had previously. Duckie >>He tells me that the prostheses for finger joint work >>really well if one is sedentery, but if a person is active at all, [quoted text clipped - 49 lines] > > Tracy  Signature_('> (_<_) _ _('< -quack (_<_) _ __('< *QUACK!* <_{__) _('< "|,,|_" (_<_) _('< "AFLAC!" (_<_) >I am also >surprised that fusion can not be done now as my doctor >always left that open as an option for the future. >Probably just the kind of surgery you have had previously. Hi Duckie, I asked my surgeon about that specifically, i.e. trying an implant and if that doesn't work, then fusing the joint. He explained to me that you need both ends of the joint to get a good fusion and those are both removed when the implants are put in. As a result you have very small and very fine bones to try to fuse together after a failed implant and the fusion frequently doesn't work. Anne AAC/AAF/AFBV62.0844.AZ http://www.tckworld.com/opfoot > I have had one of > these implants turn itself around 90 degrees but not affecting the > fingers use. That's one of the odd things I've read about Swanson implants... That even if something goes wrong down the road (crack in the implant, a turn like you describe, etc.), a lot of times it doesn't actually affect the functionality of the joint much at all. In fact, a lot of times apparently patients don't even know anything has happened until the next time it gets x-rayed! Strange, isn't it? With my PyroCarbon joint in my small finger and the dislocated one in the ring finger, apparently they are *very* good implants for longevity and wear and tear and stuff, but clearly once something goes wrong with them, you know it! I certainly do. I mean, not that I'm in excruciating pain with the dislocated joint all the time, but the pain is far worse in that finger than in the successful PyroCarbon implant in the fifth finger, and the range of motion is way, way less. > Ask your doctor if he will do > liposuction on what is left of the sawed of finger fat and skin. All [quoted text clipped - 4 lines] > likes me. He, BTW, did not do liposuction which is why I can tease > him about it. Hope whatever you do next will work. LOL, that's too funny! > I am also > surprised that fusion can not be done now as my doctor always left > that open as an option for the future. Probably just the kind of > surgery you have had previously. As Anne mentioned, it's because there's not any joint left to fuse, and fusing the two small pieces of bone that are there wouldn't likely be very successful. At least, that's what I've been told too. Tracy Tracy, Hope things go better with the finger. Thanks for posting this is informative for others. debbie m. http://www.angelfire.com/ga2/angels1/ > Hi all, > [quoted text clipped - 56 lines] > > Tracy I had all the joints in my fingers done twice. The 1st time it was the synovitis and the second time it was plastic joints. The operation was very painful and the physical theropy was a living h--l. They lasted for about 3 yrs and now 12 yrs later they are so crooked they all stick out.I have no strength in my hands at all. can hardly pick up 1/2 lb of weight. Don't want to scare you but I was never a lucky one anyway. Wish you well, God Bless Audie P>S> I have very severe RA anyway. My toes are just as crooked. Cant wear shoes. Congratulations on getting married in April, Tracy. I am sorry you have had so much problems with this finger surgery. I hope you get to the bottom of the problem and this time it will stay fixed. Wishing you the best outcome for the surgery if you have to have it again. Also hoping you have a speedy recovery. SignatureLove and hugs to all Good thoughts coming your way too. Squirrely Jo > Hi all, > [quoted text clipped - 56 lines] > > Tracy i believe I posted before about this. I had all my fingers done with plastic joints twice and it didn't last long as the tendons? all slipped off. Now all my fingers are very crooked. The same with my toes. I have no strength in my hands. Lucky if I can pick up a pound and they are very painful. Good luck with yours. Audie |
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