Reconstructive hand surgery corrects many different functional and cosmetic conditions. Rheumatoid reconstruction of the hand can repair joint deformities caused by rheumatoid arthritis. These procedures help relieve the pressure and pain and cosmetic deformities associated with this common hand disorder.

Typical hand difficulties associated with Rheumatoid arthritis include nerve compression/numbness leading to carpal tunnel syndrome, severe arthritis and deformity, tendon rupture and swelling, and cosmetic deformities of the fingers that affect function.

What is rheumatoid arthritis of the hand?

Rheumatoid arthritis is considered a systemic disease, as it can affect many different areas of the body. The joints and soft tissues become inflamed, swell, and do not function smoothly. Around two thirds of people with rheumatoid arthritis have hand and wrist problems.

With this chronic form of arthritis, the cells that lubricate and line the joints are affected. The joint cartilage and bones erode and the ligaments and tendons stretch out, making the hand and wrist look deformed. There are many classic features of hand rheumatoid arthritis. These include firm nodules along the fingers, angulation or collapse of the fingers, soft lumps on the back of the hand that moves as the fingers straighten, and deformities of the fingers.

What are the different surgical options?

There are many non-surgical and surgical options involved with rheumatoid reconstruction of the hand. Many of the decisions require complex decision making about ultimately what will benefit the patient most.  Fortunately, there are many newer medications that have reduced the need for advanced surgery in most patients. However, some patients continue to worsen in pain, function and cosmetics to still require traditional operative treatments.

Typical surgeries include Tendon Repairs and Reconstructions, Joint repairs/fusions or joint replacements, nerve releases, and removal of inflamed tissues.

When is joint replacement surgery the best surgical option?

A joint replacement procedure of the wrist, or fingers is an innovative option for treating arthritis of the hand in in well-selected patients with rheumatoid arthritis. Joint replacement surgery can provide increased finger and wrist, range of motion, improve hand function, and most importantly, pain relief. This surgery involves replacing a worn out joint with an artificial one. The new joint is most often composed of silicone rubber, metal and plastic or the patient’s own tissue, which pads the worn out bone ends.

Arthroscopy is the medical term for a procedure that our orthopedic specialists use to examine, diagnose, and repair problems inside your shoulder joint. This word comes from two separate Greek words, “arthro” meaning “joint” and “skopein” meaning “to look.” This term means “to look within the joint.”

How do I plan for a shoulder arthroscopy?

Your orthopedic specialist may ask you to see your family doctor to make sure that you do not have any health concerns that should be addressed before your procedure. You may need to have an electrocardiogram, blood tests, and a chest X-ray before your surgery. If you have any health risks, you should discuss this with the surgeon and advise him of any medications or supplements that you are currently taking.

If you are in fairly good health, your shoulder arthroscopy will most likely be performed on an outpatient basis. The surgical center will contact you before the procedure to discuss the specific details. Make sure you follow their instructions regarding arrival time and when to stop eating or drinking prior to your operation.

Before your shoulder arthroscopy, a member of the anesthesia team will discuss your anesthesia options. Most shoulder arthroscopic procedures are performed using regional nerve blocks, which numb your arm and shoulder. The numbing medicine will be injected in the base of your neck or high upon your shoulder. The nerves that control feeling in your shoulder and arm will be targeted so you do not feel anything during the operation and for several hours after your surgery to help with post-operative discomfort.

Many of our orthopedic specialists combine nerve blocks with sedation or a general anesthetic in order to make you comfortable while lying on the operating table. Most shoulder arthroscopies take less than one hour; however, the length of your surgery will depend on what the doctor finds and what repairs are necessary.

Before you undergo a shoulder arthroscopy, plan to wear comfortable clothing that is easy to put on and take off. You should also leave all watches, jewelry, and valuables at your residence. You will also have to arrange to have someone drive you home after your procedure. Plan for assistance for at least two weeks following your shoulder arthroscopy, as tasks at home may be a little difficult.

What happens during a shoulder arthroscopy?

Once you have arrived and are positioned in the surgical room, you will be placed in the beach chair position. This is a semi-seated position to allow you to be essentially reclining in a chair. The surgical team will remove the hair from the operative site if necessary, and then spread an antiseptic solution on your shoulder to properly cleanse and sterilize the surgical site. The shoulder and arm will be covered with sterile drapes, and your arm will be placed in a holding device to keep it safe and stable.

The orthopedic specialist will first inject fluid into one of the small incisions he makes on your shoulder. This makes it easier for him to insert the instruments that will be used to visualize the structures with the arthroscope. Images from this scope are projected on a TV monitor so the surgeon can see inside your shoulder clearly.

Fluid flows through the arthroscope as he guides it around the joint space of the shoulder. Once your problem is identified, the orthopedic specialist can insert tiny instruments through the buttonhole-sized incisions for the purpose of removal or repair. These specialized instruments are necessary for tasks such as cutting, suture passing, knot tying, or shaving. Once the procedure is complete, the surgeon will close these incisions with stitches or Steri-strips and cover that will a large, soft bandage.

What should I expect after my shoulder arthroscopy?

During the recovery period, you will stay in a recovery room for a couple of hours before being discharged home. The orthopedic specialist and his team will monitor your condition to make sure you are ready to travel. At home, you can expect some pain and discomfort for a least a week following the procedure. Ice is recommended to help with this and your doctor may prescribe you some medication. You are allowed to shower once your wounds are no longer draining, but should avoid prolonged soaking or scrubbing of the incisions. A special immobilizer will be issued for the purpose of protecting your shoulder. The doctor will advise you on how long this will be needed.

Rehabilitation will allow you to get back to your daily activities. This is an exercise program to help you regain your range of motion and strength in your shoulder. It is important for you to follow doctor’s orders and make a noble effort at your rehabilitation in order for full recovery to occur.

Unicompartmental Knee Replacement

The purpose of knee replacement surgery is to restore function, increase mobility, and decrease pain. Many times a total knee replacement is the best option for patients who have severe knee arthritis. However, patients with osteoarthritis that is limited to one particular area of the knee may be candidates for a partial knee replacement (also called a unicompartmental knee replacement).

What are the advantages of a partial knee replacement?

There are many research studies available that support how a modern partial knee replacement performs superbly for a vast majority of patients. There are many advantages to having a partial replacement versus a total replacement of the knee. These include a quicker recovery time, less blood loss during the procedure, and less pain after surgery.

Many report that a partial knee replacement feels more “natural” than a total replacement and the range of motion is often reported as “better”.

Who is a candidate for a partial knee replacement?

The orthopedic specialist may recommend this procedure if you have severe osteoarthritis of the knee and have tried and failed with nonsurgical treatment measures. A partial knee replacement is only considered if your knee problems affect your quality of life and interfere with your daily routine.

Also, your arthritis should be limited to one compartment of the knee, not the entire knee as seen with inflammatory arthritis. Those patients with significant knee stiffness or ligament damage are not ideal candidates.

What should I expect before the surgery?

Your orthopedic specialist, working closely with your family doctor, will determine which type of procedure you need. He may test your range of motion, the ligament quality, and assess your activity status. Patients who have pain located entirely on either the inside portion or outside portion of the knee are good candidates for a partial knee replacement.

Those who have pain throughout the entire knee or in the front aspect are usually better qualified for a total knee replacement. You may have additional imaging tests on your knee to determine which surgery suits you best.

Before your operation, a member of the anesthesia team will evaluate you. Anesthesia will either be spinal (you are awake but numb from the waist down) or general (you are completely asleep). The choice will depend on your surgeon’s preference and your health needs.

What happens during the surgery?

A partial knee replacement generally lasts 1 or 2 hours. The orthopedic specialist makes an incision at the front of your knee in order to explore the three compartments of the joint space. He uses a special saw to remove the damaged cartilage and knee components and caps the ends of the femur (thighbone) and tibia (lower leg bone) with metal coverings.

These metal pieces are connected to the bone with a special type of cement. To create a smooth gliding surface, the doctor places a plastic insert between these two metal components.

What happens after surgery?

After your procedure, you will be taken to a recovery room and closely monitored. Expect to have an IV for around 24 hours to receive medicines for pain control and antibiotics. Once you are awake, you will notice a bandage on your knee and a small drain that collects fluid from the joint space.

Some patients may be candidates to have this procedure on an outpatient basis, but most will need to be admitted to the hospital. You can expect to go home 1 to 3 days following a partial knee replacement.