Metacarpophalangeal joint replacement surgery for rheumatoid arthritis In the late 1950s and early 1960s, some surgeons used several surgical methods to correct inflammatory deformities of the metacarpophalangeal joint, including metacarpophalangeal arthroplasty, in which the metacarpophalangeal joint is removed and soft tissue is lined between the metacarpal and proximal phalanges. Although some improvement in finger alignment and joint motion was achieved after arthroplasty, the results were unreliable and recurrence of the deformity was common. In the mid-1960s, Swanson designed a flexible hinged prosthesis with more reliable results than arthroplasty. In 1975, an improved silicone elastomer became available that was four times more resistant to wear and tear. Prostheses that are widely used in clinical work today are those that have been in use since 1986 with increased resistance to fatigue/extension of the fissure. The result of metacarpophalangeal joint replacement is a painless and functional joint with a range of motion that is reliable and far superior to metacarpophalangeal arthroplasty. The flexible hinge joint is nowadays the most widely accepted method of treatment for patients with rheumatoid arthritis with severe metacarpophalangeal joint involvement. The goal of metacarpophalangeal joint replacement surgery is to relieve pain, correct deformity, and improve function and appearance. Therefore, artificial joint replacement should follow the following criteria: preservation of functional range of motion, appropriate stability to resist lateral and rotational stresses, biological compatibility, availability of joint materials, and availability of soft tissue reconstruction. Typical patients with rheumatoid arthritis typically present with ulnar deviation and palmar subluxation deformities of the metacarpophalangeal joint, pain due to synovitis, other joint deformities, and grip strength loss. Metacarpophalangeal joint replacement can correct the deformity, relieve pain, and improve the appearance, thereby improving function. Treatment options require detailed staged surgical design. Previously, metacarpophalangeal joint reconstruction surgery was used only for patients with severe deformities and severely limited function. With the use of joint replacement, the surgical results have brought confidence to the clinician, so the criteria for surgical indications have changed. The current tendency is to relax the indications for surgery to accommodate patients with slightly less severe deformity for the following reasons: 1) the amount of intraoperative osteotomy is less in patients with mild deformity than in patients with severe deformity; 2) soft tissue preservation is still intact, including the joint capsule and lateral collateral ligaments, which facilitates soft tissue reconstruction surgery. Selection of artificial joints In the past 30 years, scholars have tried a variety of artificial joints in order to obtain painless and functional metacarpophalangeal joints. These artificial joints can be divided into three design types: metal hinged prosthesis (Flatt), elastic prosthesis (Swanson), and third-generation prosthesis. The earliest hinged prostheses used for metacarpophalangeal joint replacement were simpler uniaxial prostheses, which evolved into multiaxial ones, and the materials used were diversified to include metal, ceramic, and polymorphic components. Although early clinical results were satisfactory, late recurrence of deformity, dislocation and loosening have hindered the use of these prostheses. The elastic silicone prosthesis is the most widely used, well-studied, and still one of the choices, with simple surgery, no difficulty in return, and reasonable prices. Rehabilitation A single postoperative rehabilitation program does not apply to all patients; each patient’s brace use and rehabilitation program should be individually designed based on his or her preoperative deformity and intraoperative soft tissue conditions. The postoperative brace and rehabilitation program should be tailored to the patient’s natural medical history (e.g., rheumatoid arthritis, scleroderma, systemic lupus erythematosus, etc.), the severity of the deformity prior to joint replacement surgery, and the condition of the soft tissues and flexor and extensor tendons. In our experience, patients with bilateral hand deformities who need surgery on the other hand usually opt for metacarpophalangeal joint replacement. I think that this is the best test of patient satisfaction with the surgery.