Hand arthritis is a widespread and often debilitating condition affecting millions worldwide. It leads to chronic pain, stiffness, and a significant reduction in hand function, making everyday tasks like gripping objects, writing, and buttoning a shirt challenging. While non-surgical treatments, such as medications, splinting, and physical therapy, can alleviate symptoms for many, surgery becomes necessary when these conservative measures fail to provide adequate relief.

What Causes Hand Arthritis?

Hand arthritis primarily impacts the small joints of the fingers and thumb, leading to joint deterioration and loss of function. The three most common types of arthritis affecting the hands include:

• Osteoarthritis: The most prevalent form of arthritis, caused by gradual cartilage degeneration over time, leading to bone-on-bone contact and joint stiffness.
• Rheumatoid Arthritis: An autoimmune condition in which the immune system attacks joint linings, causing inflammation, pain, and eventual joint deformity.
• Post-Traumatic Arthritis: Arthritis that develops after an injury to the hand or fingers, such as fractures or ligament damage, which accelerates joint wear and tear.

Regardless of the type, arthritis in the hand can significantly affect daily life, limiting mobility and reducing overall quality of life.

When is Surgery Recommended?

Surgical intervention is typically considered when:

• Non-surgical treatments fail to provide sufficient pain relief.
• Joint deformity or instability begins to significantly impact hand function and quality of life.
• Bone-on-bone contact occurs due to severe cartilage loss, leading to persistent pain and inflammation.
• Tendon ruptures occur as a result of arthritis progression, particularly in rheumatoid arthritis patients.

A hand surgeon will assess the severity of the condition through a combination of physical examination, imaging studies (X-rays, MRI, or CT scans), and patient-reported symptoms to determine the most appropriate surgical approach.

Surgical Options for Hand Arthritis

1. Joint Fusion (Arthrodesis)

Joint fusion is a well-established procedure that involves permanently joining two bones in the affected joint to eliminate movement and pain. This is particularly effective for severe arthritis in the distal interphalangeal (DIP) joint of the fingers. While fusion sacrifices flexibility, it provides long-term pain relief and enhanced stability, making it a suitable option for patients who prioritize function over motion.

2. Joint Replacement (Arthroplasty)

Joint replacement is an option for patients seeking to maintain joint mobility. This procedure involves replacing the damaged joint with an artificial implant made from materials like silicone, metal, or pyrocarbon. Commonly performed on the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, joint replacement restores motion while significantly reducing pain. Advances in prosthetic designs have led to improved durability and functionality for arthritis patients.

3. Thumb Basal Joint Surgery (Ligament Reconstruction and Tendon Interposition – LRTI)

The carpometacarpal (CMC) joint at the base of the thumb is highly susceptible to osteoarthritis, particularly in postmenopausal women. LRTI surgery involves removing the arthritic bone and using a tendon graft to stabilize the thumb. This procedure has demonstrated long-term success in reducing pain while preserving thumb mobility and grip strength.

4. Synovectomy

Patients with early-stage rheumatoid arthritis may benefit from synovectomy, a procedure that removes inflamed synovial tissue surrounding the joint. While this surgery does not cure arthritis, it can significantly alleviate pain and slow disease progression, particularly when combined with medical therapies such as disease-modifying antirheumatic drugs (DMARDs).

5. Tendon Transfer or Repair

In cases where chronic arthritis has led to tendon ruptures—especially in rheumatoid arthritis patients—tendon transfer or repair surgery can help restore hand function. This procedure involves redirecting a functioning tendon to replace a damaged one, improving mobility and grip strength.

6. Autologous Fat Grafting

Fat grafting, also known as fat transfer or lipofilling, can help relieve joint pain by cushioning joints and reducing inflammation. It’s a minimally invasive procedure that’s used to treat osteoarthritis, cartilage defects, and ligament and tendon injuries. Fat harvested from the abdomen or thighs is injected into the joint space and can result in long-term pain relief. 

Recovery and Rehabilitation

Recovery times vary depending on the type of surgery performed, but most patients require:

• Physical Therapy: Essential for restoring strength, flexibility, and function post-surgery.
• Splinting: Used to protect the surgical site and support healing.
• Pain Management: Includes anti-inflammatory medications, corticosteroid injections, and sometimes short-term opioid use for postoperative pain control.
• Lifestyle Modifications: Adapting daily activities and using assistive devices (e.g., ergonomic tools) can help reduce strain on the healing hand.

Healing typically takes several weeks to months, and the overall outcome depends on factors such as age, overall health, and adherence to rehabilitation protocols. The goal of surgery is not only pain relief but also to restore function and improve the patient’s quality of life.

Choosing the Right Treatment Path

Every patient’s case is unique, and choosing the right treatment involves a thorough discussion with a specialized hand surgeon. Factors such as age, lifestyle needs, severity of arthritis, and functional goals all influence the decision-making process.

For those experiencing persistent hand arthritis pain that disrupts daily activities, surgical options offer a promising path to relief and improved functionality. If you are struggling with hand arthritis and considering surgical interventions, schedule a consultation with a hand surgery specialist to explore the best treatment plan tailored to your needs.

Hand arthritis can be a frustrating and painful condition, but with the right approach—including surgical interventions when necessary—patients can regain functionality and enjoy a better quality of life. As surgical techniques and prosthetic technology continue to advance, more patients are benefiting from effective, long-term solutions tailored to their specific needs.

Author Profile: Brian Cripe, M.D., is an award-winning, board-eligible plastic and reconstructive surgeon and Plastic Surgeons of Northern Arizona partner. Dr. Cripe specializes in cosmetic surgery, limb salvage, peripheral nerve microsurgery, hand surgery, and oncologic reconstructive procedures. He has performed over 6,000 surgical cases during his nine-year tenure as a surgeon.