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Patients › Hand

Knuckle Joint Replacement (MCPJ)

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Updated Sep 20264 citations

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your appointment we take a history, examine your hand, and arrange imaging if it is needed. That assessment tells us what is wrong with the joint.

This operation replaces the knuckle joint where your finger meets your hand. It is most often offered to people with rheumatoid arthritis, a condition where the immune system inflames and damages the joints. It can also help with wear-and-tear arthritis or after an injury to the joint.

For long-standing problems we usually try non-operative care first: activity change, physiotherapy or hand therapy, and splinting. We consider surgery when those steps have not given enough improvement.

The operation aims to relieve pain and improve how the joint moves. It can also correct finger deformity and improve the appearance of your hand. Most people who do not need further surgery report lasting improvement in pain and movement. We will talk through whether it suits you, and decide together.

Before the operation

In the weeks before surgery we plan the operation using scans of your hand, such as an X-ray, MRI or ultrasound. You will get clear instructions about preparing. You will need to stop eating and drinking for seven hours before surgery. We ask for seven hours rather than six so that we can bring your operation forward if the theatre list runs early. Bring a list of your current medicines, including anything you buy without a prescription. Some medicines may need to be paused before surgery; we will tell you which ones and when. Arrange for someone to drive you home afterwards. Wear loose, comfortable clothing with sleeves that are easy to take off. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.

On the day

You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You will meet the anaesthetist, the doctor who puts you to sleep for the operation. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day.

You are then taken into the operating theatre, where the operation is performed. Afterwards you wake up in the recovery area, where nurses watch over you while the anaesthetic wears off. Once you are stable, you either move to a ward or go home the same day, depending on the procedure and how your recovery is going.

What the operation involves

The surgeon makes a cut over the back of your hand at the knuckle joint that is being treated. The worn-out joint surfaces are removed and replaced with an implant, a man-made spacer that takes the place of the damaged joint. Some implants are made of a flexible silicone rubber, which bends with your finger. Others are made of a smooth, hard material that forms new joint surfaces.

The choice of implant depends on your condition and your hand. Silicone implants are most often used for rheumatoid arthritis. Smooth, hard implants are an option for wear-and-tear arthritis. For some thumb joints, the surgeon may instead place a fold of your own tissue into the joint as a cushion, or stiffen the joint in a set position.

Once the implant is in place, the surgeon repairs the soft tissues around it to keep it stable and closes the cut with stitches. A dressing protects the hand afterwards.

The operation replaces one knuckle joint or several, depending on which joints are affected.

After the operation

You will wake up in the recovery area, then move to the ward once you are stable. Your hand will be in a dressing, and we will give you medicine to keep you comfortable. You can expect some soreness in the first day or two; tell the nurses if your pain is not well controlled. Someone should stay with you for the first 24 hours after you get home. You will be able to get up and move around soon after surgery, and your hand will be checked by the team before you leave. Your team will tell you whether you go home the same day or stay one night in hospital.

Recovery

Your hand will be sore and swollen in the first days after surgery. This settles gradually. Keeping your hand raised on pillows eases the swelling, and your pain medicine helps with the discomfort. The swelling can take a while to go down completely.

You will see Ruby Doolan at Extend Rehabilitation, our hand therapist, soon after surgery. She will guide your exercises and make any splint you need. The exercises protect the new joint while it heals, and they help your fingers bend and straighten as movement returns. You will do them at home, little and often.

In the early days you will use your hand carefully for light tasks. As the swelling settles and your grip returns, you will do more: dressing, eating, and gentle household jobs. Heavy lifting comes later, and only once your surgeon is happy with how the joint is healing. Driving is off the table while your hand is in a splint, and you need to be able to grip the wheel and react quickly before you drive again. Our guide to driving after upper-limb surgery explains the rules.

Recovery varies from person to person. Your timeline may differ, and your surgeon and hand therapist will guide you along the way.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

The new joint may not give you the strength you hoped for. Grip and pinch strength often improve only modestly, so some tasks may still feel harder than before. If this bothers you, raise it at your next review.

Some people find the little finger does not bend as much as they would like. You might notice it does not flex enough for everyday jobs like gripping a handle. Your hand therapist can suggest ways to work around this, and your surgeon can discuss what else is possible.

Sometimes a joint needs another operation later on. You might notice the finger becoming painful again, stiff, or changing shape after a period of improvement. Bring this up with your surgeon so they can assess the joint and talk through your options.

An implant can break, though this is not common. You may feel a click, a change in how the finger moves, or sudden pain in the joint. If that happens, contact the clinic rather than waiting for your next appointment.

During the operation itself, a crack can occur in the bone around the new joint. This is usually found and dealt with at the time of surgery. You may simply be told about it afterwards, and your recovery plan may be adjusted to protect the bone while it heals.

Infection in the new joint is uncommon. Watch for a deep, throbbing pain that does not ease with simple painkillers, redness spreading out from the wound, or feeling hot and generally unwell. If you notice any of these, contact the clinic straight away, or go to the emergency department if you cannot reach us.

Most people who do not need further surgery find their pain and movement improve over time.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call us if you have a fever, or if the wound becomes more red, swollen, or starts to leak fluid. Call us if you have pain that suddenly gets worse, or a deep throbbing pain that simple painkillers do not ease. Go to emergency if you have calf swelling or pain, or shortness of breath. These can be signs of a blood clot. Call us if your fingers lose feeling, or if you cannot move them. If you cannot reach us, go to your nearest emergency department.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Knuckle joint replacement is worth the extra reading because of a curiosity: the implant most used today is essentially the design introduced in the 1960s, and it has outlasted every material brought in to replace it. Understanding why explains what this operation is actually for.

Silicone has not been displaced

A 2026 review of metacarpophalangeal joint arthroplasty in rheumatoid arthritis concludes that the operation continues to play a central role in managing the rheumatoid hand, and that despite advances in implant technology, flexible silicone arthroplasty provides reliable functional and cosmetic improvement in appropriately selected patients [1].

Sixty years of materials science has produced metal-plastic and pyrocarbon alternatives, and the silicone spacer is still the reference standard. That is unusual in joint replacement, where hip and knee implants have been iterated continuously over the same period.

The reason is that this implant is not doing the job its name implies. It is not resurfacing a joint to restore a bearing. It is a flexible spacer that maintains a gap and acts as an internal splint while scar tissue forms around it into a new capsule. The result is delivered by the healing, not by the device, which is why a better bearing surface has never translated into a better outcome.

The honest summary of results

A review of implant arthroplasty across the finger and thumb joints puts it well: implant arthroplasty predictably produces pain relief and high satisfaction, but has historically suffered from high rates of complications, and while metal-plastic and pyrocarbon materials have evolved, survivorship and reoperation rates remain a concern [2].

Both halves matter. People are reliably pleased with these operations, pain goes, appearance improves, the hand works better for daily tasks, and the implants have a finite life with a real reoperation rate. Satisfaction and durability are different questions, and this operation scores much better on the first.

For osteoarthritis, the evidence is thin

Most of the literature concerns rheumatoid arthritis, because that is where the deformity being corrected is most dramatic. For osteoarthritis the picture is weaker: the available evidence consists of retrospective cohorts with small sample sizes and relatively short follow-up [3].

Notably, where authors express a preference for pyrocarbon over silicone in osteoarthritis, it is on the basis of potential for improved stability and alignment, with the data described as preliminary [3]. That is a reasonable position to hold, but it should be recognised as reasoning from mechanism rather than from demonstrated superiority.

Durability is becoming a bigger question

A concern raised nearly two decades ago has grown rather than resolved: implant durability matters more as life expectancy increases, and as these operations are done in younger, more active patients who will load them for longer [4]. An implant with acceptable ten-year performance is a different proposition at 75 than at 55.

Practically, this is a reason to be clear about what you want the operation to achieve. For pain relief, correction of deformity and improved function in a hand with modest mechanical demands, this is a well-supported operation with a long record. As a durable reconstruction for heavy use over decades, it is not.

Reviewed by Dr Kieran Hirpara · 13 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References for the advanced reading
  1. Herren DB. Balancing metacarpophalangeal joint arthroplasty in rheumatoid arthritis. J Hand Surg Eur Vol. 2026;51(6):778-84.
  2. Srnec JJ, Wagner ER, Rizzo M. Implant arthroplasty for proximal interphalangeal, metacarpophalangeal, and trapeziometacarpal joint degeneration. J Hand Surg Am. 2017;42(10):817-25.
  3. Martin AS, Awan HM. Metacarpophalangeal arthroplasty for osteoarthritis. J Hand Surg Am. 2015;40(9):1871-2.
  4. Goldfarb CA, Dovan TT. Rheumatoid arthritis: silicone metacarpophalangeal joint arthroplasty indications, technique, and outcomes. Hand Clin. 2006;22(2):177-82.
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Metacarpophalangeal joint arthroplasty is performed safely in the setting of acute complex open MCP joint trauma [1].
  • Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years [2].
  • Revision MCP arthroplasty has a relatively high rate of postoperative dislocations [2].
  • Dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years [3].
  • Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief and correction of deformity [4].
  • Patient satisfaction with silastic interposition arthroplasty of the MCPJ is high despite only modest improvements in the objective assessment of hand function [4].
  • Treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation [5].
  • The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in OA patients [7].
  • MCP joint arthroplasty is an effective treatment option from a patient-centered perspective, improving appearance, pain, and function [8].
  • Periprosthetic joint infection (PJI) is uncommon after MCP or PIP arthroplasties [9].
  • Patient expectations of MCP joint arthroplasty were uniformly high, with functional improvement being the greatest motivation for surgery [10].
  • Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty and facilitating realistic expectations [11].
  • Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction [20].
  • Implant arthroplasty of the PIP, MCP, and TMC joints has historically suffered from high rates of complications [20].
  • The evidence regarding MCP arthroplasty for OA consists of retrospective cohorts with small sample sizes and relatively short evaluations [22].

Anatomy & Pathophysiology

  • MCP joint arthroplasty was performed safely in the setting of acute complex open MCP joint trauma [1].
  • Increasing MCP joint flexion range was associated with increased fractures of silicone implants [6].
  • Nonconstrained implant designs for the MCP joint can provide good outcomes and excellent arc of motion in osteoarthritis patients [7].
  • Patients with greater hand function preoperatively may be at higher risk of revision surgery after silicone MCP arthroplasty [12].
  • Both NeuFlex and Swanson implant groups obtained satisfactory clinical improvement after MCP reconstruction in rheumatoid arthritis patients [14].
  • Swanson arthroplasty frequently results in a range of flexion of the MP joint of the little finger that may be insufficient for its principal functions [17].
  • A surgical strategy for severely collapsed zigzag thumb deformities involves gradual correction with external fixators following arthroplasty [18].
  • Not all MCP hyperextension deformities associated with trapeziometacarpal osteoarthritis require surgical interventions [19].
  • Secondary outcomes including key pinch strength, pain, the brief Michigan Hand Outcomes Questionnaire, and complications did not differ between groups at 2 years following correction of MCP hyperextension after trapeziometacarpal joint implant arthroplasty [21].
  • Thumb MCP joint capsulodesis performed concurrently with trapeziometacarpal arthroplasty can be a straightforward procedure that produces positive results [23].
  • Implant fractures following silicone MCP arthroplasty did not significantly affect upper limb function [27].
  • The hypothesis that ulnar fingers would have worse outcomes than radial fingers after silicone arthroplasty was not proven; sufficient correction of deformities in ulnar fingers is possible with adequate bone resection and realignment of the extensor mechanism [28].
  • Volar and proximal translation of the proximal phalanx was observed on 4-dimensional computed tomography after silicone implant arthroplasty in rheumatoid arthritis patients [29].
  • Implant-free anatomical reconstruction of thumb MCP joint chronic ulnar collateral ligament injuries achieved stable intra-osseous fixation and restored grip, pinch strength, and range of motion while avoiding drawbacks associated with implants [30].
  • Objective results after revision MCP surgery in rheumatoid patients following previous silicone arthroplasty were generally poor, with minimal improvement in ulnar drift, a high rate of implant fracture, and no change in arc of motion [33].
  • Maintaining finger position without recurrence of ulnar drift or extensor lag, and maintaining MCP arc of motion, corresponded with patient satisfaction after silicone MCP arthroplasty for rheumatoid arthritis [35].
  • Improvement in clinical assessments was comparable between bioreconstructive Poly-L/D-Lactide implants and Swanson prostheses, except for better maintenance of palmar alignment in the Swanson group [36].

Classification

  • MCP joint arthroplasty can be performed safely in the setting of acute complex open MCP joint trauma [1].
  • Revision MCP arthroplasty is a challenging procedure with a 20% (one in five) rate of requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations [2].
  • Dorsal capsule interposition arthroplasty is a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ [3].
  • Silastic interposition arthroplasty of the MCPJ is reliable for pain relief and correction of deformity, with high patient satisfaction despite modest improvements in objective hand function assessment [4].
  • Revision to a silicone implant is the treatment with the most promise for achieving a stable MCP joint after an acute prosthetic dislocation [5].
  • Increasing MCP joint flexion range is associated with increased fractures of silicone implants in patients with rheumatoid arthritis [6].
  • MCP joint arthroplasty is an effective treatment option for rheumatoid arthritis, improving appearance, pain, and function from a patient-centered perspective [8].
  • Patients with greater hand function preoperatively may be at higher risk of revision surgery after silicone MCP arthroplasty for inflammatory arthritis [12].
  • Both NeuFlex and Swanson implants provide satisfactory clinical improvement after MCP reconstruction in rheumatoid arthritis patients [14].
  • MCP joint arthroplasty continues to play a central role in the management of the rheumatoid hand [16].
  • Swanson silicone arthroplasty frequently results in insufficient flexion range of the little finger MP joint for its principal functions [17].
  • Not all MCP hyperextension deformities associated with trapeziometacarpal osteoarthritis require surgical intervention [19].

Clinical Presentation

  • Metacarpophalangeal joint arthroplasty is indicated for isolated degenerative or traumatic arthritis of the MCPJ [3].
  • Metacarpophalangeal joint arthroplasty is indicated for osteoarthritis of the MCP joint [7].
  • Metacarpophalangeal joint arthroplasty is indicated for noninflammatory arthritis of the MCP joints [13].
  • Metacarpophalangeal joint arthroplasty is indicated for nonrheumatic metacarpophalangeal joint arthritis [24].
  • Metacarpophalangeal joint arthroplasty plays a central role in the management of the rheumatoid hand [16].
  • Metacarpophalangeal joint arthroplasty is an effective treatment option for rheumatoid arthritis, improving appearance, pain, and function [8].
  • Patient expectations of MCP joint arthroplasty are uniformly high [10].
  • Functional improvement is the greatest motivation for MCP joint arthroplasty surgery [10].
  • Hand appearance is a patient motivation for surgery and a determinant of satisfaction with MCP joint arthroplasty for rheumatoid arthritis [10].
  • Implant arthroplasty of the MCP joints predictably produces pain relief and high satisfaction [20].
  • Silastic interposition arthroplasty of the MCPJ results in high patient satisfaction despite only modest improvements in the objective assessment of hand function [4].
  • Silicone arthroplasty for nonrheumatic arthritis results in excellent pain relief and excellent patient satisfaction [24].
  • Pain ratings significantly improve following surface replacement arthroplasty in MCP joints affected by noninflammatory arthritis [13].
  • The arc of motion significantly improves following surface replacement arthroplasty in MCP joints affected by noninflammatory arthritis [13].
  • Silicone arthroplasty for nonrheumatic arthritis results in improved range of motion and DASH score [24].
  • Swanson silicone arthroplasty frequently results in a range of flexion of the MP joint of the little finger that may be insufficient for its principal functions [17].
  • Increasing MCP joint flexion range is associated with increased fractures of silicone implants [6].
  • One in five patients requires a revision procedure at 5 years following revision MCP arthroplasty [2].
  • Squeaking in pyrolytic carbon MCP joint replacement can be associated with pain and swelling [34].

Investigations

  • Patient satisfaction is high following silastic interposition arthroplasty of the MCPJ despite only modest improvements in the objective assessment of hand function [4].
  • Increasing MCP joint flexion range was associated with increased fractures of silicone implants in patients with rheumatoid arthritis [6].
  • The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in osteoarthritis patients [7].
  • MCP joint arthroplasty is an effective treatment option from a patient-centered perspective, improving appearance, pain, and function in rheumatoid arthritis [8].
  • Patients with greater hand function preoperatively may be at higher risk of revision surgery after silicone metacarpophalangeal joint arthroplasty in inflammatory arthritis [12].
  • Pain ratings and MCP arc of motion significantly improved following surface replacement arthroplasty in metacarpophalangeal joints affected by noninflammatory arthritis [13].
  • Both NeuFlex and Swanson metacarpophalangeal implants obtained satisfactory clinical improvement after MCP reconstruction of the hand in rheumatoid arthritis [14].
  • The articulated spacer technique can be considered an option to maintain motion while treating infected MCPJ arthroplasties, avoiding co-morbidity resulting from immobilisation [15].
  • Metacarpophalangeal joint arthroplasty continues to play a central role in the management of the rheumatoid hand [16].
  • The study proposes a surgical strategy for severely collapsed zigzag thumb deformities using gradual correction with external fixators [18].
  • Not all MCP hyperextension deformities will require surgical interventions according to known algorithms [19].
  • Secondary outcomes including key pinch strength, pain, the brief Michigan Hand Outcomes Questionnaire and complications did not differ between groups at 2 years in the correction of MCP hyperextension following trapeziometacarpal joint implant arthroplasty [21].
  • The evidence regarding MCP arthroplasty for osteoarthritis consists of retrospective cohorts with small sample sizes and relatively short evaluations [22].

Treatment

  • Metacarpophalangeal joint arthroplasty can be performed safely in the setting of acute complex open MCP joint trauma [1].
  • Secondary outcomes including key pinch strength, pain, the brief Michigan Hand Outcomes Questionnaire and complications did not differ between groups at 2 years following correction of metacarpophalangeal joint hyperextension following trapeziometacarpal joint implant arthroplasty [21].
  • Silicone arthroplasty for nonrheumatic metacarpophalangeal joint arthritis showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction [24].
  • Intraoperative fractures occurred in 3% of MCP joint arthroplasties and were associated with pyrocarbon implants, cementless fixation, and diabetes mellitus [25].
  • Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients following pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthritis at minimum 5-year follow-up [26].
  • The indications for and long-term expectations of silicone metacarpophalangeal arthroplasty must be carefully examined in light of the improvements in the medical management of rheumatoid disease [31].
  • A long stem ulnar prosthesis, with or without radial osteotomy, is advocated as a salvage procedure for failed Sauve-Kapandji procedures resulting in fracture of the proximal phalanx pyrocarbon implant [32].

Complications

  • The treatment of acute MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation [5].
  • PJI is uncommon after MCP or PIP arthroplasties [9].
  • Patients with greater hand function preoperatively may be at higher risk of revision surgery after silicone MCP arthroplasty in patients with inflammatory arthritis [12].
  • Implant arthroplasty of the MCP joints has historically suffered from high rates of complications [20].
  • Complication and overall reoperation rates were high for pyrocarbon arthroplasty in MCP joints affected by rheumatoid arthritis [37].
  • One in 10 patients with pyrocarbon arthroplasty for rheumatoid arthritis undergo revision within 5 years postoperatively [37].
  • Metacarpophalangeal arthroplasty using a pyrocarbon implant for osteoarthritis demonstrates a 7% revision rate at 5 years after surgery [38].

Recovery

  • Revision MCP arthroplasty is a challenging procedure [2].
  • One in five patients require a revision procedure at 5 years [2].
  • There is a relatively high rate of postoperative dislocations following revision MCP arthroplasty [2].
  • Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief [4].
  • Silastic interposition arthroplasty of the MCPJ is reliable in terms of correction of deformity [4].
  • Patient satisfaction is high following silastic interposition arthroplasty of the MCPJ [4].
  • There are only modest improvements in the objective assessment of hand function following silastic interposition arthroplasty of the MCPJ [4].
  • MCP joint arthroplasty is an effective treatment option from a patient-centered perspective for rheumatoid arthritis [8].
  • MCP joint arthroplasty improves appearance for patients with rheumatoid arthritis [8].
  • MCP joint arthroplasty improves pain for patients with rheumatoid arthritis [8].
  • MCP joint arthroplasty improves function for patients with rheumatoid arthritis [8].
  • Patient expectations of MCP joint arthroplasty were uniformly high [10].
  • Functional improvement was the greatest motivation for surgery in patients undergoing MCP joint arthroplasty [10].
  • Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty [11].
  • Joint goal-setting facilitates realistic expectations for patients undergoing MCP arthroplasty [11].
  • Pain ratings significantly improved following surface replacement arthroplasty in metacarpophalangeal joints affected by noninflammatory arthritis [13].
  • MCP arc of motion significantly improved following surface replacement arthroplasty in metacarpophalangeal joints affected by noninflammatory arthritis [13].
  • HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint demonstrates satisfactory short- to mid-term outcomes [40].
  • HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint results in considerable improvements in pain relief [40].
  • HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint results in considerable improvements in joint mobility [40].

Key Evidence

  • [L4] MCP joint arthroplasty was performed safely in the setting of acute complex open MCP joint trauma. [1] (10.1016/j.jhsa.2015.09.012)
  • [L4] Revision MCP arthroplasty is a challenging procedure with one in five patients requiring a revision procedure at 5 years and a relatively high rate of postoperative dislocations. [2] (10.5435/jaaos-d-17-00042)
  • [L4] This technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years. [3] (10.1177/1558944720911215)
  • [L4] Silastic interposition arthroplasty of the MCPJ is reliable in terms of pain relief and correction of deformity, and patient satisfaction is high despite only modest improvements in the objective assessment of hand function. [4] (10.1054/jhsb.2000.0402)
  • [L4] The treatment of MCP joint arthroplasty dislocation with revision to silicone implant appears to hold the most promise in achieving a stable MCP joint after an acute prosthetic dislocation. [5] (10.1016/j.jhsa.2017.10.001)
  • [L4] Increasing MCP joint flexion range was associated with increased fractures of the implants. [6] (10.1016/j.jhsa.2020.09.002)
  • [L5] The nonconstrained implant design for the MCP joint can have good outcomes and excellent arc of motion in OA patients. [7] (10.1016/j.jhsa.2012.11.025)
  • [L4] MCP joint arthroplasty is an effective treatment option from a patient-centered perspective, improving appearance, pain, and function. [8] (10.1016/j.hcl.2006.02.001)
  • [L4] PJI is uncommon after MCP or PIP arthroplasties. [9] (10.1016/j.jhsa.2024.12.008)
  • [L1] Patient expectations of MCP joint arthroplasty were uniformly high, with functional improvement being the greatest motivation for surgery. [10] (10.1016/j.jhsa.2011.02.002)
  • [L4] Joint goal-setting is essential for understanding patients' unique reasons for undergoing MCP arthroplasty and facilitating realistic expectations. [11] (10.1002/msc.1061)
  • [L3] Patients with greater hand function preoperatively may be at higher risk of revision surgery. [12] (10.1177/1558944719831236)
  • [L4] Pain ratings and MCP arc of motion significantly improved following arthroplasty. [13] (10.1177/15589447211028917)
  • [L1] Both implant groups obtained satisfactory clinical improvement after MCP reconstruction of the hand. [14] (10.1016/j.jhsa.2009.09.020)
  • [L5] The articulated spacer technique can be considered an option to maintain motion while treating infected MCPJ arthroplasties, avoiding co-morbidity resulting from immobilisation. [15] (10.1177/17531934251323067)
  • [L5] Metacarpophalangeal joint arthroplasty continues to play a central role in the management of the rheumatoid hand. [16] (10.1177/17531934261430139)
  • [L4] Our experience with this cohort, a review of published literature, and a survey of international experts suggest that Swanson arthroplasty frequently results in a range of flexion of the MP joint of the little finger that may be insufficient for its principal functions. [17] (10.1007/s11552-007-9051-5)
  • [Paper] The study proposes a surgical strategy for severely collapsed zigzag thumb deformities using gradual correction with external fixators. [18] (10.1007/s12593-015-0178-2)
  • [L4] Not all MCP hyperextension deformities will require surgical interventions according to known algorithms. [19] (10.1007/s00402-021-03838-8)
  • [L4] Implant arthroplasty of the PIP, MCP, and TMC joints predictably produces pain relief and high satisfaction but has historically suffered from high rates of complications. [20] (10.1016/j.jhsa.2017.07.030)
  • [L3] Secondary outcomes including key pinch strength, pain, the brief Michigan Hand Outcomes Questionnaire and complications did not differ between groups at 2 years. [21] (10.1177/17531934251330975)
  • [L4] The evidence regarding MCP arthroplasty for OA consists of retrospective cohorts with small sample sizes and relatively short evaluations. [22] (10.1016/j.jhsa.2015.05.019)
  • [L4] Thumb MCP joint capsulodesis performed concurrently with trapeziometacarpal arthroplasty can be a straightforward procedure that produces positive results. [23] (10.1016/j.jhsa.2014.07.045)
  • [L3] This study showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction in patients undergoing MCP arthroplasty for nonrheumatic arthritis. [24] (10.1016/j.jhsa.2013.09.016)
  • [L3] Intraoperative fractures occurred in 3% of MCP joint arthroplasties and were associated with pyrocarbon implants, cementless fixation, and diabetes mellitus. [25] (10.1016/j.jhsa.2014.12.038)
  • [L4] Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients. [26] (10.1016/j.jhsa.2015.06.104)
  • [L4] However, implant fractures did not significantly affect upper limb function. [27] (10.1016/j.jhsa.2024.01.009)
  • [L2] The hypothesis that ulnar fingers would have worse outcomes than radial fingers was not proven; sufficient correction of deformities in ulnar fingers is possible if adequate bone resection and realigning of the extensor mechanism are carefully performed. [28] (10.1016/j.jhsa.2009.06.029)
  • [L4] Volar and proximal translation of the proximal phalange was observed on 4-dimensional computed tomography. [29] (10.1016/j.jhsa.2021.10.001)
  • [L4] The surgical procedure achieved stable intra-osseous fixation and restored grip, pinch strength, and range of motion while avoiding drawbacks associated with implants. [30] (10.1177/17531934231182895)
  • [L4] Given these findings, the indications for and long-term expectations of silicone metacarpophalangeal arthroplasty must be carefully examined in light of the improvements in the medical management of rheumatoid disease. [31] (10.2106/00004623-200310000-00001)
  • [L4] The authors advocate the use of a long stem ulnar prosthesis, with or without radial osteotomy, as a salvage procedure for failed Sauve-Kapandji procedures. [32] (10.1177/1753193410384891)
  • [L4] Objective results, however, were generally poor, with minimal improvement in ulnar drift, a high rate of implant fracture, and no change in arc of motion. [33] (10.1016/j.jhsa.2007.07.026)
  • [L5] If squeaking is associated with pain and swelling, revision MCP joint arthroplasty is recommended to identify and correct the underlying cause, such as implant subsidence or an incongruous joint. [34] (10.1016/j.jhsg.2022.10.002)
  • [L2] However, maintaining finger position, without recurrence of ulnar drift or extensor lag, and MCP arc of motion corresponded with patient satisfaction in the postoperative period. [35] (10.1016/j.jhsa.2011.09.042)
  • [L1] Improvement in clinical assessments was comparable in both groups, except for better maintenance of palmar alignment in the Swanson group. [36] (10.1177/1753193410375777)
  • [L4] Complication and overall reoperation rates were high, while 1 in 10 undergo revision within 5 years postoperatively. [37] (10.1177/15589447211063577)
  • [L4] Metacarpophalangeal arthroplasty using a pyrocarbon implant for osteoarthritis demonstrates a 7% revision rate at 5 years after surgery. [38] (10.1016/j.jhsa.2022.08.013)
  • [L4] The HAPY spherical pyrocarbon interposition arthroplasty for the metacarpophalangeal joint demonstrates satisfactory short- to mid-term outcomes, with considerable improvements in pain relief and joint mobility. [40] (10.1016/j.jhsg.2025.100804)

References

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[2] Revision Metacarpophalangeal Arthroplasty: A Longitudinal Study of 128 Cases. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00042

[3] Dorsal Capsule Interpositional Arthroplasty of the Metacarpophalangeal Joint. HAND. 2020. DOI: 10.1177/1558944720911215

[4] Outcome Measures Following Metacarpophalangeal Joint Replacement. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0402

[5] Outcomes Following Acute Metacarpophalangeal Joint Arthroplasty Dislocation: An Analysis of 37 Cases. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.10.001

[6] Risk Factors Contributing to Early Implant Fracture in Silicone Metacarpophalangeal Joint Arthroplasty for Patients With Rheumatoid Arthritis. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.09.002

[7] Clinical and Radiographic Outcomes of Metacarpophalangeal Joint Pyrolytic Carbon Arthroplasty for Osteoarthritis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.11.025

[8] Rheumatoid Arthritis: Silicone Metacarpophalangeal Joint Arthroplasty Indications, Technique, and Outcomes. Hand Clinics. 2006. DOI: 10.1016/j.hcl.2006.02.001

[9] Incidence and Presentation of Periprosthetic Joint Infection After Primary Metacarpophalangeal and Proximal Interphalangeal Arthroplasty. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.12.008

[10] Hand Appearance as a Patient Motivation for Surgery and a Determinant of Satisfaction with Metacarpophalangeal Joint Arthroplasty for Rheumatoid Arthritis. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.02.002

[11] Patients' Expectations, Experiences and the Determinants of Satisfaction related to Metacarpophalangeal Arthroplasty. Musculoskeletal Care. 2013. DOI: 10.1002/msc.1061

[12] Factors Associated With Reoperation After Silicone Metacarpophalangeal Joint Arthroplasty in Patients With Inflammatory Arthritis. HAND. 2019. DOI: 10.1177/1558944719831236

[13] Outcomes of Surface Replacement Arthroplasty in Metacarpophalangeal Joints Affected by Noninflammatory Arthritis. HAND. 2021. DOI: 10.1177/15589447211028917

[14] NeuFlex and Swanson Metacarpophalangeal Implants for Rheumatoid Arthritis: Prospective Randomized, Controlled Clinical Trial. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.09.020

[15] Management of an infected metacarpophalangeal joint replacement with a temporary articulated cement spacer. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251323067

[16] Balancing metacarpophalangeal joint arthroplasty in rheumatoid arthritis. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261430139

[17] Insufficient Flexion of the Metacarpophalangeal Joint of the Little Finger Following Swanson Silicone Arthroplasty for Rheumatoid Arthritis. HAND. 2007. DOI: 10.1007/s11552-007-9051-5

[18] Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series. Journal of Hand and Microsurgery. 2015. DOI: 10.1007/s12593-015-0178-2

[19] Does trapeziectomy with ligament reconstruction and tendon interposition arthroplasty correct the metacarpophalangeal joint hyperextension associated with trapeziometacarpal osteoarthritis?. Archives of Orthopaedic and Trauma Surgery. 2021. DOI: 10.1007/s00402-021-03838-8

[20] Implant Arthroplasty for Proximal Interphalangeal, Metacarpophalangeal, and Trapeziometacarpal Joint Degeneration. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.07.030

[21] Correction of metacarpophalangeal joint hyperextension following trapeziometacarpal joint implant arthroplasty: a case–control study. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251330975

[22] Metacarpophalangeal Arthroplasty for Osteoarthritis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.019

[23] Volar Capsulodesis of the Thumb Metacarpophalangeal Joint at the Time of Basal Joint Arthroplasty: A Surgical Technique Using Suture Anchors. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.07.045

[24] Silicone Arthroplasty for Nonrheumatic Metacarpophalangeal Joint Arthritis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.09.016

[25] Intraoperative Periprosthetic Fractures Associated With Metacarpophalangeal Joint Arthroplasty. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.038

[26] Pyrocarbon Metacarpophalangeal Joint Arthroplasty in Noninflammatory Arthritis: Minimum 5-Year Follow-Up. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.104

[27] Long-Term Implant Fracture Rates Following Silicone Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.01.009

[28] Outcomes of Silicone Arthroplasty for Rheumatoid Metacarpophalangeal Joints Stratified by Fingers. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.06.029

[29] In Vivo Metacarpophalangeal Joint Kinematics After Silicone Implant Arthroplasty in Patients With Rheumatoid Arthritis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.10.001

[30] Implant-free anatomical reconstruction of thumb metacarpophalangeal joint chronic ulnar collateral ligament injuries. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231182895

[31] METACARPOPHALANGEAL JOINT ARTHROPLASTY IN RHEUMATOID ARTHRITIS. The Journal of Bone and Joint Surgery-American Volume. 2003. DOI: 10.2106/00004623-200310000-00001

[32] Fracture of the proximal phalanx pyrocarbon implant after metacarpophalangeal arthroplasty. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193410384891

[33] Results of Revision Metacarpophalangeal Joint Surgery in Rheumatoid Patients Following Previous Silicone Arthroplasty. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.07.026

[34] A Painful, Squeaking Pyrolytic Carbon Metacarpophalangeal Joint Replacement. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.10.002

[35] Objective Functional Outcomes and Patient Satisfaction After Silicone Metacarpophalangeal Arthroplasty for Rheumatoid Arthritis. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.09.042

[36] Bioreconstructive Poly-L/D-Lactide Implant Compared With Swanson Prosthesis in Metacarpophalangeal Joint Arthroplasty in Rheumatoid Patients: a Randomized Clinical Trial. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410375777

[37] Outcomes of Pyrocarbon Arthroplasty in Metacarpophalangeal Joints Affected by Rheumatoid Arthritis. HAND. 2022. DOI: 10.1177/15589447211063577

[38] Metacarpophalangeal Joint Pyrocarbon Arthroplasty for Osteoarthritis: An Analysis of 44 Arthroplasties. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.08.013

[40] Functional Outcomes of Spherical Pyrocarbon HAPY Metacarpophalangeal Interposition Arthroplasty for Long Fingers: A Retrospective Study of 16 Cases. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100804

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