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Health Answers

Hand and wrist repair innovations

By Judy Foreman
April 6, 2009
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Q. I've heard of surgery to repair hips and knees riddled with arthritis. Is there anything similar for hands and wrists?

A. Yes. Although many hand and wrist problems associated with rheumatoid arthritis respond relatively well to medication alone, others - especially those linked to osteoarthritis - are increasingly being treated with surgery.

For painful or damaged wrists, the best solution is often old-fashioned fusion, says Dr. Andrew Jawa, a hand, elbow, and shoulder surgeon at Boston Medical Center. Fusion means surgically merging one of the bones of the arm (the radius) and the tiny bones of the wrist ( the carpal component), according to Jawa. Because the bones are fused, the person loses mobility in the wrist, but pain is often dramatically reduced.

With full joint replacement, like that done for hips and knees, more sophisticated technology is now making it possible to fix damaged knuckles and fingers, says Dr. Jesse Jupiter, chief of the upper hand extremity service at Massachusetts General Hospital. The most commonly replaced joint is the base of the thumb, called the basal joint - a joint that doesn't exist in other primates.

Historically, doctors used Silastic, a kind of rubber, to replace this joint, but now they increasingly use various combinations of ceramics and metals (typically cobalt and chrome), which can be shaped to more precisely mirror the shape of the joint itself.

Finger and wrist joint replacements have lagged behind knee and hip replacements mostly because hand pain is not as disabling.

But "we use our hands for everything," says Jupiter, adding that joint replacement for fingers and knuckles is growing steadily.

Newer prostheses and new materials mean that surgery is now an increasing option for people whose hands and wrists are damaged from osteoarthritis, he said.

E-mail health questions to foreman@globe.com.

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