When arthritis affects the fingers, in addition to pain and stiffness, patients may have difficulty picking up objects or holding them in their hands. Sometimes severe joint deformity occurs, leading to permanent disfigurement.

In early stages of arthritis, doctors will usually try supportive treatments, like rest, exercise, joint protection and medications. The goal of therapy is to relieve pain and improve joint function and quality of life. When those treatments don’t help, surgery may be recommended.

With the fingers, there are two main options for severe joint damage: fusion and replacement. In joint fusion, an incision is made in the skin over the joint. The ends of the bones are exposed and roughened. Then, donor pieces of bone are placed inside the joint. As the bones heal, the ends fuse, forming a single bone.

Joint fusion eliminates the joint, and thus, the ability to move that part of the finger. However, it greatly reduces pain and improves quality of life. Joint replacement is a procedure in which the damaged joint is surgically removed and replaced with an artificial joint.

Kenneth Means, Jr., M.D., Hand Surgeon with Union Memorial Hospital in Baltimore, says artificial knuckle joints are typically made of silicone or metal. The type of replacement is typically dependent upon the level of activity and quality of the diseased joint. If patients don’t have a significant amount of deformity, a metal replacement may be used. But if the joint is seriously deformed and the ligaments are not healthy, a silicone replacement is usually preferred.

After a knuckle replacement, patients need therapy to regain range of motion and build strength in the joint. Means says patients may not regain full range of motion, but at least they will have relief from pain. About 70 to 80 percent of knuckle replacements last about ten years.

Knuckle replacement can be done on any of the fingers. However, Means says the knuckle closest to the end of the fingers is often treated with joint fusion rather than replacement.