Arthrodesis and Arthroplasty of the Small Joints

Abstract Arthritis of the small joints of the hand is a common problem encountered by orthopaedic hand surgeons. Nonoperative management is maximized to include splinting, injections, therapy in some situations, and oral analgesics. Pain is the main indication for joint arthroplasty and arthrodesis of the small joints of the hand. Additional indications include deformity, stiffness, and joint incongruity as seen in degenerative and inflammatory arthritis. We describe specific indications for treatment of the metacarpal phalangeal, finger proximal and distal interphalangeal, and thumb interphalangeal joints. Treatment options include open debridement of painful osteophytes, arthroplasty, and arthrodesis. Bone and soft-tissue stability is necessary to support an implant, thus treatment is dependent on the soft-tissue envelope and the amount of joint destruction. Based on the literature and the authors’ experience, arthrodesis is a better alternative than arthroplasty in most cases.