Do you experience unbearable pain in your big toe with every step you take? Is it very difficult to put on shoes? Perhaps the joint in your big toe is worn out or damaged. In such a situation, when all other treatments have failed, the solution that doctors recommend is joint replacement surgery. Let's talk about this simply and clearly.
Simply put, what is this finger joint replacement surgery?
A toe joint replacement surgery involves surgically removing the damaged, worn-out joint in your toe and replacing it with an artificial joint. This artificial joint is called a ``prosthesis.'' These are made of metal, ceramic, or plastic. They are designed to function just like a healthy joint.
This surgery is most often performed on the joint in the big toe. Medically, this is called the metatarsophalangeal (MTP) joint. This is the main joint that connects your big toe to your foot. This joint has to bend with every step we take. So imagine how painful it would be to walk if this joint were worn, stiff, and damaged.
The common name for these joint replacement surgeries is arthroplasty. It is similar to knee replacement and hip replacement surgeries. However, it is less common to perform finger replacements.
Why do you need to have this kind of surgery?
This surgery is a last resort. That is, a doctor will only consider it if other treatments have failed to control your pain. The following are usually the first treatments tried:
- Wearing special shoes or braces: Make walking easier.
- Activity modification: Reduce pressure on the joint.
- Painkillers: To control pain as prescribed by the doctor.
- Physical therapy: Improve joint function and strength.
- Steroid injections: Temporarily reduce pain and swelling.
If all of this doesn't help, you may need to consider surgery. This surgery can be a solution to joint pain caused by the following conditions:
| Medical condition | A simple explanation |
|---|---|
| Bunions (hallux valgus) | A painful bump that forms when a bone protrudes from the back of the big toe. |
| Hallux rigidus | A condition in which the joint of the big toe becomes worn, stiff, and unable to bend properly. This is also called a "stiff big toe." |
| Injury | Damage to the joint due to injuries, such as a broken bone in the finger. |
| Osteoarthritis | Joint degeneration due to age or other causes. |
| Osteonecrosis `(Osteonecrosis)` | Bone tissue dies due to impaired blood supply to the bones. |
| Rheumatoid arthritis | Swelling and pain caused by the body's own immune system attacking the joints. |
What is the difference between replacing a joint and fusing a joint?
This is a question that many people ask. In addition to replacing a joint, doctors sometimes recommend a surgery called "arthrodesis or fusion."
- Fusion: This involves permanently fusing the two bones that make up a joint. This stabilizes the joint and completely eliminates pain. But the most important thing is that after the surgery, the joint cannot be moved. It is fixed in one place.
- Joint Replacement: Since an artificial joint is inserted in this procedure, you will still be able to bend and extend your finger, that is, move the joint, even after surgery.
Imagine that when a hinge on a door breaks, you put in a new hinge (this is like replacing it). Otherwise, you nail that part of the door and strengthen it so that it doesn't move (this is like soldering). Your doctor will decide what is best for you.
What happens before the surgery?
Before performing this type of surgery, your orthopedic surgeon will examine you carefully.
- They will ask about your general health and any other illnesses.
- They ask about the pain in your finger, how long it has been there, and how it is affecting your daily life.
- They examine the finger, looking at things like its strength and how far it can bend (range of motion).
- An X-ray of the foot will definitely be done to check the condition of the bones.
- Other tests, such as blood tests, may be done to see if you are suitable for surgery.
What happens during the surgery?
This surgery is usually done in a hospital or other facility with operating room facilities. It can take about two to three hours. Here are some things that happen during the surgery:
1. First, you will be anesthetized. This means that you will be completely asleep with a drug given into a vein in your arm.
2. The surgeon will then make a small incision on the top of your finger.
3. Through that incision, the damaged joint and worn-out cartilage and bone fragments are removed.
4. Next, the previously measured and prepared artificial joint `(prosthesis)` is inserted into that place.
5. This artificial joint is attached to the bones on either side of the finger with small pins, screws, or a special type of cement called ``bone cement.''
6. Make sure the artificial joint is in the correct position and is properly secured.
7. Check to see if the finger bends and moves properly.
8. The surrounding tissues, such as tendons and nerves, are repositioned.
9. Finally, the incision is closed with stitches.
10. Then, to protect against germs, it is wrapped in bandages and sometimes a plaster `(cast)` is applied.
What happens after the surgery?
After the surgery, you will wake up in a recovery room. Your leg will be wrapped in bandages and possibly in a cast or a special boot. The medical team will monitor you for any side effects from the anesthesia.
You will be kept in the hospital until you can walk safely using crutches or a walker . Before you go home, your doctor and nursing staff will give you instructions on how to care for your finger. These may include:
- Applying ice to the finger to reduce pain and swelling.
- Keeping your legs elevated as long as possible.
- The day I have to come back to break the stitches.
- Wearing shoes with hard soles as much as possible.
What are the benefits and risks of this surgery?
As with any surgery, there are benefits and very rare risks. Your doctor will explain these to you in detail.
| Benefits | Potential Risks |
|---|---|
| Pain relief: The severe pain experienced while walking is relieved. | Infection: There is a small chance of infection in the wound or transplanted joint. |
| Increased mobility: The ability to bend and extend the finger increases. | Problems with the artificial joint: The implanted part loosens, breaks, or jumps. |
| Restoration of function: Walking and daily tasks become easier. | Nerve damage: Temporary or permanent damage to the nerves in the area of surgery. |
| Reduced swelling and stiffness: The stiffness and swelling in the joint are reduced. | Blood clots: A rare condition. |
How long does it take to recover? How can I take care of myself at home?
Your doctor will encourage you to use your new joint, which means walking, as soon as possible after surgery. Exercise is a very important part of the healing process. Although it may be a little painful at first, walking will gradually become easier over time.
You may also need to undergo physical therapy. It may take about 8 weeks to fully put weight on your toe and walk. These tips will help you recover quickly and safely:
- Arrange for someone to help with household chores: Having someone to help you in the first few days after surgery is a great convenience.
- Remove obstacles in your home: Remove things that could cause you to slip and fall, such as rugs and wires running along the floor.
- Use aids: Use crutches, a walker , or bathroom grab bars to reduce the weight on your finger.
When should I see a doctor immediately?
It is very important to recognize any problems that may arise after surgery. If you have any of the following symptoms, call your surgeon immediately.
| Signs of an infection (if one or more of these are present) | |
|---|---|
| Fever or feeling cold. | Pus oozing from the suture site or a foul odor. |
| Persistent or increasing pain. | Redness or swelling around the incision. |
| Over time, signs of joint failure | |
| Decreased function or strength of the joint. | Recurrence of pain, stiffness, or swelling. |
| Feeling of instability in the joint (feeling like it is going to "jump"). | |
Take-Home Message
- Toe Joint Replacement is a successful solution for severe pain and joint damage that has not been cured by other treatments.
- The main goal of this surgery is to relieve your pain, improve your ability to walk, and improve your quality of life.
- It takes time to fully recover after surgery. It is very important to follow the doctor's instructions and physical therapy exercises exactly.
- If you develop signs of infection or other unusual symptoms after surgery, notify your doctor without delay.
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