The rheumatoid metacarpophalangeal joint

Reconstruction of the MP joint affected by rheumatoid disease can pose a challenge to the surgeon and therapist. The multiple initiating and aggravating factors must be taken into consideration during the planning phase before they can be addressed surgically. The results following surgery at the MP joint are dependent on a number of factors. The most important of these is the general activity of the rheumatoid disease and the patient's response to medical treatment. The individual who requires steroids and antimetabolites may observe a general worsening of his disease state, which will be uninfluenced by surgery at the MP joints. Patients demonstrating vasculitis may have problems with wound healing and remobilization following MP joint surgery. The surgeon's ability to rebalance the MP joint is directly related to the quality of the periarticular soft tissues needed for the reconstructive procedure. The ability of an individual to cooperate in a postoperative program and to apply the principles of joint protection is absolutely necessary. The eventual joint motion is related to tendon function in the hand.