What is it ? (Definition)
Osteoarthritis is the destruction of joint’s cartilage by wear. We often see it in knees and hips, but the proximal (PIP) and distal (DIP) interphalangeal joints of the fingers are actually the most common sites for this disease.
Three symptoms are usually associated with various severity: Pain, Deformity, Lack of Motion.
How to diagnose it? (Presentation)
Clinical examination reveals a increased volume with deformation and often painful stiffness.
Plain radiography allows to visualize joint destruction and to estimate the severity.
What will happen if you do nothing ? (Natural evolution)
The functional situation can remain globally unchanged for several years, with punctual episodes of acute crisis.
Nevertheless, the situation may progressively deteriorate, until reaching a point where conservative or restorative options would not be possible anymore.
Then, only palliative procedure would be relevant.
The deterioration of the situation is not necessarily correlated with the pain and fuctionnal limitation, and often requires additional exams to be thoroughly assessed.
For this reason, follow-up is usually recommended even for patient who are reluctant to a surgical treatment in first line.
What are the therapeutical options ? (Treatment)
In the absence of functional or aesthetic disturbance, and if the deformation is not painful, therapeutical abstension is the rule.
Mild forms can benefit from occupational therapy and occasional NSAID.
Intra articular injections of steroids or hyaluronic acid are still controverted.
In case of painful stiffness, or unaesthetic deformation, surgical treatment may be indicated.
At the metacarpo-phalangeal (MCP) and proximal interphalangeal joint level (PIP) :
– Joint arthroplasty can decrease the pain and increase mobility, but has a limited survival time and may be associated with instability problems, especially on heavy workers.
– Joint fusion (« arthrodesis ») decreases the pain and provides total stability in a functional position for an unlimited amount of time, but forbids any motion on the fixed joint, although the overlying and underlying joints remains mobile.
At the distal interphalangeal joint (DIP), prostheses are not usable.
It is, however, possible to act on the painful and unsightly nodules, which can be removed by a short surgical procedure. In the most severe cases, joint fusion (« arthrodesis ») can be proposed.
What is the postoperative care ?
Depending on the type of surgery performed, the postoperative care may require early physiotherapy with early range of motion, and/or the use of a splint that can be static (immobilisation) or dynamic.
Patient’s involvement during this phase is of paramount importance to the final result.
What are the expected results?
– If all goes well :
The pain decreases and even disappears sometimes, and the finger becomes globally more functional.
MCP arthroplasties aim to provide mobile and pain-free joints. The lifespan of the prostheses, however, is limited to a few years, and it is then necessary to proceed to the re-operation.
Joint fusion (« arthrodesis ») usually provide a good functional result despite the absence of motion of the fixed joint.
Return to normal activities is gradually allowed after 6 weeks, with restrictions in heavy work up to the third month.
The operated joint usually remains swollen for several months.
– In case of problem :
Joint prosthesis (MCP &PIP) eventually detach from the bone and become painful. This is called implant loosening. Rarely, the prostesis can aslo dislocated.
Arthrodesis (IPD) may not correctly merge immediately and require a new operation. This is called non-union. This complication is rare.
Occasionally, the surrounding tendons sticks into their sheath and lead to post operative stiffness.
Some cases of persistant and unexplained postoperative pain has been described.
As in any operation, the theoretical risk of infection exists but this complication remains rare, thanks to the rigor of prevention protocols.
Other complications may occur but appears to rare to be mentioned here.
Dr Franck ATLAN