Arthritis or trauma can cause irreversible damage to the joints of the fingers, leaving ongoing pain, stiffness and swelling. Where that damage involves the knuckle or the middle joint of the finger, replacing the joint with an implant relieves the pain and restores useful movement. It is a day procedure taking about 45 minutes per finger, followed by a splint and a structured hand therapy programme through the first six weeks. The goal is a comfortable finger that moves usefully, not a normal one.
When a finger joint is worth replacing
Arthritis or trauma can cause irreversible damage to the joints of the fingers. This results in ongoing pain, stiffness and swelling, and loss of function is most noticeable when it involves the PIP joints, the middle joints of the fingers, or the MCP joints, the knuckles.
Those two joints carry most of the arc of finger movement. A stiff painful knuckle affects everything you do with a closed hand, and a stiff painful middle joint affects everything you do with a curved one. In advanced cases, replacement of the involved joint or joints with an implant can be the treatment option of choice.
The joint nearest the fingernail is a different problem with a different answer. That one is usually fused rather than replaced, because it needs to be stable more than it needs to move. That is covered on our page on DIP joint osteoarthritis.
Who it suits
Joint replacement in the hand suits people whose pain is coming from a specific damaged joint, whose surrounding tendons and ligaments are in reasonable condition, and whose demands on the hand are moderate rather than heavy.
It is used most often in rheumatoid arthritis, where the knuckles drift and deform, and in osteoarthritis or post traumatic arthritis of a single middle finger joint. It is less suited to someone doing heavy manual work, because an implant in a small joint has a finite tolerance for load.
Fusion is the alternative. A fused joint is permanently stiff but strong, painless and durable. Replacement keeps movement at the cost of some strength and a device that may not last forever. Which of those is right depends on which joint, which finger, and what you need the hand to do, and it is the main conversation to have at the consultation.
VIEW A VIDEO OF OUR FINGER JOINT REPLACEMENT CONSULT
Dr Paul van Minnen
Dr Nicholas Smith
How it is assessed
Examination looks at where the pain actually comes from, how much movement the joint has now, whether the joint is stable, and the condition of the tendons that will have to work across the new joint. An X-ray shows how much of the joint is left and whether the neighbouring joints are also involved.
Movement before surgery is the best predictor of movement afterwards. A joint that already moves reasonably and simply hurts does better than one that has been stiff for years, which is worth knowing when deciding on timing.
Non-surgical treatment first
Hand therapy, splinting, activity modification and anti-inflammatory measures all have a place, and for many people they postpone or avoid surgery altogether. Where the arthritis is inflammatory rather than degenerative, getting the medical treatment right first is more important than any operation, and we will work with your rheumatologist on that.
The operation
Your PIP or MCP joint is replaced with an implant. In most cases the implant is made of silicone. In some cases an alternative implant type, metal and Teflon or pyrocarbon, is used.
An incision is made on the back of the affected joint. The damaged joint surfaces are removed to allow placement of the implant, and the overlying tendons are rebalanced to gain the optimal range of motion afterwards. The wound is closed using sutures, and a tape bandage covers it under a soft hand dressing.
The operation usually takes place as a day surgery procedure, using general anaesthesia with a local anaesthetic for comfort afterwards, and takes about 45 minutes per finger.
Rebalancing the tendons is a significant part of the operation and part of why the therapy afterwards matters so much. A new joint sitting under tendons that pull unevenly will not move well however good the implant is.
Recovery, week by week
Indicative. This operation depends on hand therapy more than most, and the schedule below is built around it.
Timeframe
What to expect
Day of surgery
Some or all of your fingers may feel numb or tingly for one to three days because of the local anaesthetic. You can move the fingers not included in the dressings for light tasks before you leave hospital.
Days 1 to 7
Keep the dressing clean and dry. You will be referred to a hand therapist, who replaces the dressings with a custom made thermoplastic removable splint. There will be swelling of the hand and fingers.
Days 7 to 14
The splint can be removed for gentle hand and finger exercises as instructed by your hand therapist, but should be worn at all other times. The tape bandage on the fingers can get wet under the tap or shower when gently cleaning your hand.
Two weeks
Your progress is reviewed by the doctor, practice nurse or hand therapist, and the sutures are removed at this visit. If needed, a new tape bandage goes on for another three to five days. With guidance from the therapist you increase movement and reduce splint use over the next two weeks.
One to two weeks
Most people are driving again at one to two weeks, depending on which finger was operated on and how confident you are steering safely. Office work is usually manageable over the same period.
Four to six weeks
At four weeks the splint is replaced with tape or straps connecting the operated finger to an adjacent finger, which is called buddy taping. This assists in increasing movement of the finger.
Six weeks
All splinting and taping can stop. You can increase use of the hand and fingers for a graded return to normal duties. Light manual work is generally manageable from four to six weeks, and heavy work after six weeks.
Two to three months
In most cases the wound heals in two to three weeks and exercises increase gradually and comfortably. In some cases the finger remains tender or swollen for two to three months after surgery. The hand therapist and surgeon continue to assist you.
The splint is not there to keep the finger still. It is there to hold it in the right position between exercise sessions, which is a different job, and it is why removing it to do the exercises is part of the plan rather than a lapse.
Hand therapy
Therapy is not an optional extra after this operation. The therapist makes the splint, sets the pace of movement, manages the swelling, moves you onto buddy taping at four weeks and takes you off splinting at six. The range of movement you finish with is largely decided in those six weeks. Having therapy on site means it starts within the first week and continues without interruption.
What to expect from the result
The goal of finger joint replacement surgery is pain relief, and that is what it delivers reliably. The new finger joint will not move as much as a normal, healthy finger joint. The finger may not straighten and bend fully.
That is the honest position and it is worth having clearly in mind beforehand. People who came for pain relief are usually very pleased. People who expected a normal finger are not, even when the operation has gone exactly as intended.
Risks and complications
The procedure is routine and safe, and complications are uncommon. When they occur they can include:
- Wound healing problems or infection.
- Bleeding or bruising. Usually minor and settles on its own.
- Nerve or tendon injury. Uncommon. The tendons crossing the joint are worked on during the operation and rebalanced.
- Ongoing tenderness, swelling or stiffness, or slower than expected recovery. Most of these cause temporary problems only.
- Implant failure or recurrent stiffness. The implant may fail in the long term, or the replaced joint may become stiff again. If this happens, further surgery may be required.
When to be seen sooner
Contact us, or see your GP, if you have:
- A finger joint that is painful at rest or waking you at night
- A knuckle that is drifting sideways, particularly with rheumatoid arthritis
- Rapid loss of movement in a joint over weeks
- A joint that has become unstable or gives way
- Redness, spreading pain, fever or a hot swollen joint, which needs to be seen urgently
If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
How long does the operation take, and will I be asleep?
About 45 minutes per finger, as a day surgery procedure under a general anaesthetic with a local anaesthetic for comfort afterwards. You go home the same day.
What is the implant made of?
In most cases silicone, which has a long track record in finger joints. In some cases an alternative implant is used, either metal and Teflon or pyrocarbon, depending on the joint and the condition of the surrounding structures. We will explain which is planned for you and why.
How much will the finger move afterwards?
More than it did if it was stiff and painful, and less than a normal finger. The joint will not move as much as a healthy one and the finger may not fully straighten or fully bend. How much movement you finish with depends heavily on how much you had beforehand and on the therapy through the first six weeks.
Should I have a fusion instead?
For some joints and some people, yes. A fusion is permanently stiff but strong, painless and durable, which suits a heavily used hand or the joint nearest the fingernail. A replacement keeps movement at the cost of some strength and a device that may not last forever. Which is right depends on the joint, the finger and what you need your hand to do.
When can I drive and go back to work?
Most people are driving again at one to two weeks, depending on which finger was operated on and whether you can steer and perform an emergency stop confidently. Office work over the same period. Light manual work at four to six weeks, and heavy work after six weeks. There is no legislation covering surgery and driving, so the test is whether you can control the car safely.
Can more than one joint be done at once?
Yes, and it is common in rheumatoid arthritis where several knuckles are involved. The operating time increases by about 45 minutes per finger and the therapy programme is the same. We will discuss how many to do in one sitting.
How long will the implant last?
Silicone finger implants have a long track record, but they are not permanent and an implant may fail in the long term or the joint may stiffen again. If that happens further surgery may be required. This is one of the reasons the operation suits moderate rather than heavy hand demands.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution before anything is booked. Phone the rooms on (08) 7127 0365 for an estimate.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 10 September 2026