Joint Replacement: It's Not Just Knees and Hips

Most people associate joint replacement with knees and hips. But joints in the hand, wrist, ankle, and shoulder can be just as painful and debilitating. Fortunately, improved materials and surgical techniques have expanded joint replacement choices for people with arthritis.

For a person with severe joint pain and disability from arthritis, joint replacement can mean freedom from pain and a return to most normal activities.

New Knuckles for Arthritis Pain Relief
Rheumatoid arthritis can severely damage the function and appearance of the main knuckles (metacarpophalangeal joints). Osteoarthritis typically affects joints in the fingers. The three main types of knuckle replacement are silicone, metal-plastic, and pyrolytic carbon.

• Silicone knuckle implants are placed between the finger bones as "spacers" after the eroded bone has been removed. These implants, which are not as strong as the other types, keep the finger bones from rubbing together until enough scar tissue forms to preserve the space separating the bones.
• Metal-plastic joints are two-piece implants made of cobalt chrome metal and polyethylene (hard plastic). These implants rely on a metal ball and plastic socket to provide greater joint strength and mobility.
• Pyrolytic carbon implants are similar in design and function to metal-plastic joints but are made of a high-strength, exceptionally durable ceramic-like material.

Wrist Implants for Arthritis Pain Relief
Wrist-replacement surgery is performed to relieve pain and to preserve the function of the hand and wrist. Several types of wrist implants are available for people with arthritis. Most consist of two metal components with a polyethylene spacer inserted between the two.

Wrist-replacement surgery for arthritis-related pain may be performed as an outpatient procedure. Recovery and rehabilitation take about two to three months, with the wrist first in a cast and then in a splint. Most people who complete their rehabilitation program can expect their new wrist to provide about half the range of motion of a healthy, natural wrist.

Ankle Replacement for Arthritis Pain Relief
Before total ankle replacement was available, ankle fusion was the only treatment available for chronic, severe arthritis-related ankle pain. In the fusion procedure, the ankle joint is removed and the tibia (shinbone) is fused with the talus (the first large bone in the foot). Fusion relieves pain for most people with arthritis but leaves the ankle area stiff and with limited mobility. It is used primarily in younger, active individuals, often as a stopgap measure to delay the need for an ankle replacement.

Total ankle replacement may be a good option for people in their 50s or older with arthritis who don't participate in high-impact activities such as tennis. An ankle implant simulates the function and movement of the natural ankle and offers more mobility than does fusion.

Shoulder Replacement for Arthritis Pain Relief
Shoulder replacement involves inserting an artificial ball and socket to replace a damaged shoulder joint. You will need to be cautious with your new shoulder, especially in the early months after surgery. Some activities will be off-limits for the rest of your life. These include strenuous lifting and pushing and pulling, as well as contact sports that could dislodge or break the implant. You also should avoid any activities that involve throwing (such as playing softball) or strenuous, repeated arm movements (such as using a hammer or chopping wood).

As is true for all joint replacements, you should faithfully do the recommended exercises after your surgery. This is the most important step you can take to regain and maintain mobility in your shoulder.