Arthritis can take a heavy toll on hands, causing pain, deformity and disability. Yet surgery to repair the damage from hand arthritis is relatively rare. According to the Agency for Healthcare Research and Quality, fewer than 1,000 finger surgeries were performed in 2009 compared with nearly one million hip and knee replacements. One reason is that finger surgery has a high complication and failure rate and often sacrifices mobility for pain relief.

Still, for people who have severe pain not relieved by conservative measures, the trade-off can be worth it, according to hand surgeon Amy Ladd, MD, a professor of orthopaedic surgery at Stanford University Medical Center in Stanford, Calif.

"Pain relief is far and away the reason we perform surgical procedures [for hand arthritis]," she says.

Fusion vs. Replacement
The two main surgical options for hand arthritis are fusion (arthrodesis) and total knuckle replacement (arthroplasty). In arthrodesis, the bones of the joint are fused together, creating a stronger, more stable and essentially pain-free knuckle, but one with little flexibility or movement.

Arthroplasty involves removing the damaged joint and inserting an artificial implant in its place. The goal is to relieve pain and restore shape and some function in the hand, but the results are usually less satisfactory than with hip and knee replacements.

One problem is that hinged finger implants don't fully replicate normal finger motion. And most are made from silicone rubber, which is flexible but breaks and slips easily. Some studies have found that up to 30 percent of silicone implants fail within 10 years, making them a poor choice for younger patients.

"Over the last few years, implants have gotten much better, but they are far from perfect," Dr. Ruch says. "The hope is that some of the newer metal-and-plastic implants [which are designed more like a ball-and-socket joint] will hold up better than silicone."

Jose Ortiz, Jr., MD, a hand surgeon at Mayo Clinic Health System in Eau Claire, Wis., has a somewhat different perspective, noting, "Sometimes even the best artificial joint is not as good as a banged-up real joint, so you have to be very, very careful."

Whether arthrodesis or arthroplasty is used depends mainly on the joint needing repair but also on a person's age, activity level and the amount of stiffness the finger – and patient – can tolerate. It's not uncommon to have both procedures performed on different joints in the same hand.

Here's a closer look at the two surgeries and the joints where they're commonly used.

Metacarpophalangeal (MCP) joint. Arthroplasty is almost always used to repair the knuckles at the base of the fingers, where flexibility and motion are crucial. The MCP joints – the largest in the hand – are critical to finger function but can be seriously damaged by rheumatoid arthritis (RA).