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Trends in Rheumatoid Hand Surgery: Indications, Techniques, and Outcomes.

Masanori Nakayama¹, Yasuhiro Kiyota², Soichiro Nakamura¹

¹Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita Hospital, 852 Hatakeda, Narita 286-8520, Japan.

Journal of Clinical Medicine

|January 25, 2025

Summary

This summary is machine-generated.

Surgery for rheumatoid hand deformities is evolving with RA medications. Soft tissue procedures are effective for early stages like ulnar deviation, while implants or arthrodesis are for severe joint destruction.

Keywords:

hand and finger deformity joint replacement joint-preserving arthroplasty rheumatoid arthritis ulnar deviation

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Area of Science:

Orthopedic Surgery
Rheumatology
Hand Surgery

Background:

Rheumatoid arthritis (RA) causes persistent synovitis and arthritis, leading to joint deformity and destruction.
RA medications have advanced, altering surgical indications and techniques for RA-induced joint deformities over 30 years.

Purpose of the Study:

To review recent trends in surgical management of rheumatoid hand/finger deformities.
To present current surgical methods and outcomes for these conditions.

Main Methods:

Review of previous reports on surgical trends for rheumatoid hand deformities.
Presentation of the authors' recent surgical techniques and patient outcomes.
Analysis of surgical interventions based on the severity of joint destruction and deformity (e.g., ulnar deviation, swan-neck, boutonniére).

Main Results:

Advances in RA medication have decreased the incidence of hand deformities, but they persist in long-term or difficult-to-treat cases.
Soft tissue surgery is effective for deformities with preserved joint structures, including ulnar deviation, swan-neck, and boutonniére deformities.
Implant arthroplasty or arthrodesis is necessary for severe joint destruction or irreducible dislocations.

Conclusions:

Surgical indications and methods for rheumatoid hand deformities have shifted due to improved RA management.
Soft tissue-only procedures are effective for many rheumatoid hand deformities, offering an alternative to implants.
Hand surgeons must adapt surgical strategies to the evolving presentation of rheumatoid hands, selecting appropriate methods based on disease stage and joint integrity.