Success in Total Joint Replacement: Management of Finger Joints

The history of joint replacement is far from being a success story. The main cause of destruction in finger joints is rheumatoid arthritis. The excentic displacement of tendons in rheumatoid hands generates high deviating loads on the destroyed joints. Recentration of the deviating forces by constrained endoprotheses is frequently followed by fracture or loosening of the implants. As long as reliable repair of the periarticular structures with recentration of the force transmitting flexor tendons is not possible, unconstrained endoprostheses tend to luxate and semiconstrained implants will act similarly to constrained replacements. Silicone arthroplasty, which was developed by Swanson about 50 years ago, avoids these problems. Scar formation around the silicone implant, called an encapsulation process, corrects joint deviations and allows a limited range of motion. Silicone arthroplasty is still the golden standard in finger joint arthroplasty. New modifications of the silicone implants afford slightly better ROM values.