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Without a doubt, you can easily think of a friend or family member who had undergone a replacement for their knee or hip but when it comes to having a knuckle replaced, that may be a more challenging feat. I, myself, was not even aware that knuckle replacement was still being performed as medications for arthritis have improved significantly in the last few decades but you learn something new every day. 

Yes, knuckle replacement therapy is still alive and well and is generally indicated in patients who are no longer responsive to anti-arthritic medications. These patients will also need to have severe involvement of their hands in order to be considered to be a candidate for this operation. The two most common diseases that lead to this deformity would be rheumatoid arthritis and osteoarthritis. 

Just because you have this hand deformity does not mean that you will be guaranteed to be a candidate to have knuckle replacement surgery, however. A surgeon can decide to replace the whole knuckle, called a total knuckle replacement. He can also elect to do a fusion of the knuckle or he can decide to just remove some of the damaged cartilage that could be causing the discomfort without doing a replacement at all. 

What he ultimately decides to do depends almost entirely on where you find the most discomfort and deformity. The knuckle is a more complex unit that you may have ever imagined and it is actually composed of 3 distinct parts. The small segment connects your fingers to the base of the knuckle and this part is almost always untouched due to the fragility of this connection. It is a region that does not usually respond well to a replacement surgery so a fusion procedure will be done instead to relieve pain in the area. 

The middle segment of the knuckle is usually replaced, especially in the third and fourth finger. This is because these digits are most responsible for dexterity and gripping so you will notice an immediate improvement, or handicap if this segment is impaired. If it is the middle knuckle of the index finger, the standard of care will be a fusion procedure as well because of how readily you will use this joint. The prosthetics are prone to damage after high use so they are not the best choice in this situation. 

The bottom knuckle is where the knuckle connects to the rest of your hand and it is almost always replaced. 

It is a very straightforward surgery and most are conducted on an out-patient basis. That means you will not have to stay overnight in the hospital. According to studies, about 90 percent of patients notice the improvement immediately after the surgery and pain almost disappears. You may not have the full dexterity that you once had before your autoimmune disease surfaced but it is a good option to regain some independence. 

Recovery time can vary but after about 6 to 12 weeks of rehabilitation, patients should have close to full strength back in their hands. [1]

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