One of the characteristic effects of rheumatoid arthritis on the hands is a drift of the fingers towards the little finger - known as ulnar drift. It is cosmetically ugly but frequently painless and the function of the hand remains remarkably good. If surgery is indicated then I usually replace all the finger metacarpo-phalangeal (MCP) joints in one operation. In my opinion it results in a more functional hand. However there are always exceptions and each patient's case has to be assessed individually.
This is quite major surgery in a small area and thus there are increased risks and Complications. The main indication for surgery is always going to be the relief of pain, but recovery or preservation of function is close behind. The operation involves excising the old joint, inserting the new silastic prosthesis and then realigning the soft tissues. The post-operative period is also very important and particularly involves time with the hand therapists. Splintage is required, using both firm supportive and softer, functional splints for over six weeks. The soft tissue reconstruction is a critical part of the procedure and it is this factor more than anything else which is the reason why splintage is required for so long.