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Health Information The Buzz on ... Hand, Wrist and Elbow Joint Replacement

Among the hundreds of thousands of Americans who have joint replacement surgery each year — usually because of damage caused by osteoarthritis or rheumatoid arthritis — most get new hips or knees. Joint replacement in the upper extremities (the elbows, wrists and knuckles) occurs much more rarely. But for people with hands and arms so stiff and painful that they can't do such routine activities as washing the dishes or using a toothbrush, it's no less necessary.

An Uncommon Solution
Fortunately, says Mark Cohen, MD, an orthopedic surgeon at Rush, the upper extremities aren't as likely as hips and knees to disable people so severely: They are less prone to arthritis damage and easier to treat with more conservative approaches, such as rest. "You can't avoid using your knee if you want to get around," Cohen says. "But you can avoid using your index finger."

Sometimes, though, pain and immobility grow severe enough that joint replacement becomes the best solution for hands, wrists and elbows damaged by arthritis or traumatic injury (another, less common, reason for these procedures).

A Return to Form
Cohen and his colleagues John Fernandez, MD, and Robert Wysocki, MD, also hand, wrist and elbow specialists at Rush, perform between five and 10 knuckle replacements a month and about 15 wrist and 15 elbow replacements a year. "We are one of the only medical centers to have such a high volume of joint replacements for the upper extremities," Cohen says. "And in this area, experience is important because these are relatively complicated procedures with many nuances."

In lieu of the damaged bones, the surgeons insert artificial joints that range from small, molded pieces of silicone (to replace knuckles) to multipart hinges made of metal and hard plastic (to replace wrist and elbow joints). They operate on an outpatient basis using local anesthetic, which means patients usually go home on the same day they undergo the procedure.

Once they have had the procedure, these patients must avoid heavy lifting (often anything that weighs more than five pounds) and work with a physical therapist to learn strategies for doing their daily activities in ways that minimize stress on their new joints (such as using wrist supports while typing). But such restrictions pale in comparison with the new freedom the joints can provide to those who need them. "They can give people their lives back," Cohen says.
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