Is Small Joint Replacement an Option for the Hands and Feet?

Close up of son holding his mothers hands
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Question: Is joint replacement an option for the small joints of hands and feet?

Answer: This is a question often asked. Unfortunately, the answer is not what you would expect. If we can replace a knee or hip, why can’t we replace a toe or finger joint? Finger joint replacements were tried over 20 years ago, with disastrous results. The first joints were made of hinged stainless steel. These were bulky and did not provide full flexion.

The replacement joints often rotated along the long axis, causing the fingers to twist. In addition they were very prone to fracture. After awhile these prostheses were dropped in favor of silastic finger implants. Although these worked well, they too fractured easily and were not used very long. Thumb implants and great toe implants are available but are not widely used. I am aware of a new revolutionary anatomic neutral finger joint designed at Brown University of Medicine. The Neuflex implant is reported to provide improved flexion of the knuckle joints, without the increased incidence of fracture. Also ADL (activities of daily living) performance is said to improve with use of the new prosthesis. To my knowledge, there is no proven replacement for the small joints of the toes. (Answer provided by the late Dr. Raymond Federman, aka Dr. Bones, who passed away on September 2, 2003. The care of his patients even in retirement was always his joy.)

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