Aging knees, hips get replaced - and sometimes fingers, too

USA Today—March 1, 2012

Small joints can throw some of the biggest curves later in life, says nonagenarian Barbara Stetson.

Between the tennis court, golf course, knitting club and her needlepoint, Stetson gives her hands a rigorous workout. The past several years, her fingers have been troubled by severe arthritis, a disease that strikes one in five U.S. adults and is the leading cause of disability. The swelling and intense pain sidelined her, but only temporarily.

"My attitude is to get it fixed and to move along," says Stetson, 91. "I don't want to give up my favorite activities."

Stetson, of Southport, Conn., has had 11 hand surgeries; the most recent allowed her to resume playing tennis and to look forward to hitting the golf ball when the season opens in April. Her surgeon performed finger joint arthroplasty on her right hand's middle finger, eliminating the pain and improving the joint's range of motion. He'd performed previous replacements in two fingers on her left hand, and she's also had joint fusion surgery.

"So much of medicine today is geared toward keeping people active," says Stetson's doctor, Scott Wolfe, a hand and upper extremity surgeon at Hospital for Special Surgery in New York. "She chose a procedure that could give her back motion and allow her to continue her active lifestyle."

While finger joint replacement is an uncommon surgery, Wolfe says more older people should consider it rather than abandon a sport that enhances a healthy lifestyle. He adds that advances in technology and the way the surgery is performed make it more successful than when introduced in the 1950s.

The finger implant resembles a miniature total knee replacement. The surgery he performed on Stetson involved the second joint from the finger tip, the proximal interphalangeal (PIP) joint, which is key to helping the hand make a fist.

"We chose arthroplasty for Mrs. Stetson, knowing it would not last forever," says Wolfe. "It might break down. For someone in their 80s or 90s, though, they probably don't think about that a whole lot."

Stetson's lifestyle and expectations were made known: Her hands were the only joints slowing her down. She says she will not need the more common hip or knee replacements. Wolfe says finger joint implants will never be as common as hips and knees, partly because the finger joint problem won't exist as often. Only 917 surgeries were performed on fingers in 2009, compared with 285,471 hip replacements and 621,000 knee replacements, according to the Agency for Healthcare Research and Quality.