ARTIFICIAL FINGER JOINTS
There were more than 440,000 total joint replacement procedures performed in 1999. Hip and knee replacements are the most common, and account for 98 percent of joint replacement procedures. Arthritis is the common culprit when a joint is needed. Yet, arthritis affects more than just hips and knees. It's also common in the hands and fingers - now, doctors are replacing the smaller joints with more success. And they're not just for arthritis patients.
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Across the country, hip and knee replacements are routine, but smaller joint replacements have been more of a challenge.
Kathleen Robertson, M.D.
Orthopedic Surgeon
Tulane University
New Orleans, LA
"You're using your fingers and your joints all day long, so you have to think that the wear or the breakdown may be higher, may be faster."
Now, these new artificial joints give people more mobility. They're made of the same material used in heart valves.
Kathleen Robertson, M.D.
"We know that after your heart beats many, many millions of times a year, that those valves have not worn out. That's where the idea of the actual metal for this implant came from was because of the long track record."
Unlike typical silicone implants, the new implants withstand frequent wear and tear. Doctor Kathleen Robertson says that's crucial.
Kathleen Robertson, M.D.
"What you're trying to give back to them is painless motion."
They can help arthritis patients or patients who have suffered an injury, like Michael, who nearly lost his finger to a saw blade.
Michael Smith
Has an artificial joint
"It cut the bone completely in half, and it dropped the finger down to here. There was only a piece of skin right here holding it, holding it on."
Doctors saved his finger, but pain and limited mobility followed. The artificial joint helped.
Michael Smith
"It's been a lot better. I have pain medicine, but I don't take it unless I really have to."
After 19 months of rehab, he's gone back to his construction job.
Michael Smith
"I've heard stories about other people cutting themselves, and I just didn't think it was going to happen to me. Be very careful when you're cutting with power saws because it can happen to anybody."
With his new joint, Michael is sure to take his own advice.
Doctor Robertson says the best candidates for artificial joints are those who have osteoarthritis, a young person who has traumatic arthritis - like Michael - or a person who has early rheumatoid arthritis. The joints were recently FDA approved so any surgeon has the capability of using them.
BACKGROUND: Joint replacements can improve the lives of patients who have experienced some type of destruction to the cartilage that cushions joints. Any harm to this cartilage can cause severe destruction to the entire joint. Both rheumatoid and osteoarthritis are common causes for the destruction of joints. Osteoarthritis, or old-age arthritis, causes gradual destruction to joint tissue. A third cause is post-traumatic arthritis, occurring after an event like a football injury or a saw blade accident. While joint replacement has long been common and successful for larger joints, like the hip and knee, finger joint replacement has not enjoyed the same success. Kathleen Robertson, M.D., from Tulane University, attributes this discrepancy to the fact that most patients with rheumatoid arthritis "see the orthopedic surgeon very late, after most of the destruction and instability have occurred, so it's very hard to give those people any function back." Because the joints in the fingers undergo so much action, just from daily life activities, researchers have had difficulty finding a material for joint replacements that could withstand long-term wear and tear.
NEW MATERIAL WORKS: Past materials used in joint replacements have included metals like titanium and stainless steel, polyethylene, and silicone. Because the metal materials are stiffer than bone, stress is placed on the bones surrounding the replacement joint. Stephen Cook, Ph.D., also from Tulane University, notes that the mismatch "is not as much of a problem in the hip, where the bones are big and thick. But in the hands, the bones have very small, thin cortices, and the stress transfer of the prosthesis to the bone is critical." Using existing technology, researchers have created replacement finger joints out of prelatic fibrocarbon, the same material used in heart valve replacements. The durability of this material has already been proven. "We know that after your heart beats many, many millions of times a year ... the metal has not worn out," says Dr. Robertson. There have been no incidents of corrosive or inflammatory reactions. Use of this material for finger joint replacements in the United States was approved in the fall of 2001, but Dr. Robertson recalls its use in Europe for about 10 to 15 years.
LONG TERM BEHAVIOR: Not all arthritis patients are eligible for this type of finger joint replacement. Other treatments may be more beneficial, depending on the patient's level of pain, degree of debilitation, and range of motion. It is important to try more conservative treatments, like steroid injections and splints. Then, a decision between joint fusion and this new type of joint replacement must be made. Since the ultimate goal is to provide the patient with the maximum amount of motion and the minimum amount of pain, the new joint replacement is a logical choice for some. The long-term behavior of this material in the body has been proven. Dr. Robertson says, "We know it has been trusted in somebody's heart, and hearts have continued to beat without failure."
Fran Simon, Public Relations Director
Tulane University Health Sciences Center
(504) 588-5221
fsimon@tulane.edu
Copyright © 2003 Ivanhoe Broadcast News, Inc.
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