What is an MCP joint replacement?
The metacarpal phalangeal (MCP) joints are the knuckle joints of your hand. Due to conditions like rheumatoid arthritis or osteoarthritis, using your hand can become difficult due to pain, reduced range of movement and deformity of the fingers. The surgical procedure involves replacing the arthritic MCP joint with something less painful. This is usually a silicone implant or a ‘spacer’. There are different types of replacements available depending upon your condition.
The operation is most frequently performed in those with rheumatoid arthritis and it is common for all four finger joints to be affected and replaced at the same time. In osteoarthritis, there is a tendency for fewer joints to be replaced and usual management consists of conservative measures being pain relief, medication and joint protection advice.
Pain is usually the main reason why patients consider having an MCP joint replacement, although in those with rheumatoid arthritis, correcting the deformity and improving the appearance of the hand may be a reason to consider surgery. Following surgery the function should improve, however you may lose full grip.
What complications can occur?
The risks of surgery are low. Generally the most common problems with this type of surgery are:
- Infection – is always a possibility following any surgical procedure, therefore it is very important to keep the dressings clean and dry. Infections are easily treated with antibiotics. If you feel your dressing needs changing please contact the hospital via the numbers below.
- Bleeding – from the wound may also occur and to minimise this it is therefore important to keep the hand elevated during the first 48-72 hours following your surgery.
- Nerve damage – the small, superficial nerve branches to the skin at the back of the hand maybe at risk with this operation, leading to reduced sensation around the scar region. Although the lack of sensation may be irritating, it should settle.
- Swelling, stiffness and scar pain – swelling should reduce in the first week of the operation. Local swelling around the surgical site can persist for many months. Often the joint(s) being replaced may become very stiff and the resultant post-surgical joint movement may be limited. This is the most common complication post joint replacement.
- Chronic regional pain syndrome (CRPS) – this can be a debilitating post-surgical complication causing increased pain, stiffness and swelling. Severe CRPS occurs in less than 1% of cases. The recovery can be varied with the risk of long term residual disability; often joint stiffness and unpleasant pain symptoms.
- Implant failure including fracture, loosening or dislocation of the components – implant failure is a long term complication of the joint replacement due to loosening or fracture and may require further surgery. Dislocation is a risk in the short term with the risk being low. Should this occur manipulation under anaesthetic is usually needed.
- Recurrent soft tissue deformity – over time the original deformity and appearance of the hand (ulnar-drift – a medical condition that causes the joints in the wrist and hand to shift so that the fingers bend toward the ulnar bone on the outside of the forearm) can re-occur. This can be a result of the failure of the soft tissue. The re-occurrence of the deformity maybe well tolerated, on occasion further surgery may be necessary.
This is a day case procedure which involves having either a general anaesthetic (asleep) or regional anaesthetic (whole arm goes numb). The procedure involves an incision across the top of the knuckle joints of your affected hand (if all knuckles are to be replaced), or a single knuckle if one joint is to be replaced. The joint capsule is incised to expose the joint and the affected joint is removed. The new implant(s) is later inserted into the joint and soft tissue structures around the joint will be repaired and centralised to improve the alignment of the fingers.
Although this is usually a day case procedure, you may need to be admitted onto the ward, either on the day of the operation or the day before. You are usually ready to go home within 24 hours following your surgery.
What happens before the operation?
Prior to admission you may need to have a pre-operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. Before the date of your admission, please read very closely the instructions given to you.
If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose an anaesthetic risk and we may have to cancel your surgery. You should bath or shower before coming to hospital. Please trim your nails and keep your hands clean. Remove any rings your might have on the operation side.
What to expect following surgery
Following surgery your hand will be placed in a plaster cast and bulky dressing. This is usually in place for approximately two weeks, although it may be longer. You will receive an appointment to have both the cast and stitches removed around two weeks post-surgery.
Once your stitches have been removed and the wound has fully healed, you should massage your scars daily with a non-perfumed moisturising cream such as E45, aqueous or Vaseline. This will help to soften the scars and reduce adhesions.
After your operation you will be referred to physiotherapy at the Queen Elizabeth Hospital. You will be provided with additional splints and exercises to achieve the maximum amount of movement possible, especially bending. The physiotherapist will guide you through your recovery.
The splints are worn to help you protect your joints. One splint will hold your fingers straight, the other splint will hold your fingers in a bent position. You will need to alternate using these two splints as guided by your physiotherapist, and will need to wear them at all times for the first 4 weeks, removing only for exercise and hygiene purposes. After this time, you will reduce wearing the splint throughout the day but will continue to use at night and for going outdoors.
Immediately you can start to move your elbow and shoulder after your operation to prevent stiffness. This can be done frequently throughout the day.
Hand exercises will be provided at your first physiotherapy appointment. You will be guided on a progressive rehabilitation programme following your surgery. It is important to follow the guidance by the physiotherapist to aid your recovery, range of movement and function.
You will not be able to drive during the first few months after the operation. Driving should be avoided until you can make a tight fist without pain and safely control the car in an emergency stop.
- You will not be able to use your hand for any activity for the first four weeks following surgery. After this time you will be able to start light daily activities with your hand.
- You are advised not to make a full fist for six weeks
- After eight weeks post-surgery, you can start returning to your normal activities. You will be guided by your physiotherapist
- If you notice any sudden onset of pain, swelling, redness or signs of infection please contact the team on the telephone numbers below. Should the splint become uncomfortable, cause sensory changes or increased swelling, please contact the physiotherapy team.
During the hours of 8am – 8pm contact the Day Surgery Unit, North East NHS Surgery Centre, Queen Elizabeth Hospital 0191 445 3009
During the hours of 8pm – 8am contact the Day Surgery Unit, North East NHS Surgery Centre, Queen Elizabeth Hospital 0191 445 3005
During the hours of 0800 – 1630 contact the Physiotherapy Department (please ask to speak to the upper limb physiotherapist or a member of the team) 0191 445 2320
Main Switchboard 0191 482 0000