My Silicone Saviors: Knuckle Replacement for Rheumatoid Arthritis

When I screamed after bumping my finger, I knew I couldn’t keep ignoring the pain. Doctors initially dismissed my plight, and it was after my mom mentioned silicone knuckles that I saw a possible solution.

Fumbling to button my 2-year-old’s coat, the sharp, shooting pain in my bulging middle knuckle made me yelp. Although I attempted different angles and positions, my stiff fingers couldn’t align the button with its buttonhole.

Frustrated, I changed my daughter’s favorite floral coat to the pink-dotted parka, which pulled over her head. She complained and resisted, adding a heaping dose of mom guilt to the situation.

For months, I’d been living with a swollen, painful index finger, watching it gradually change shape. When I couldn’t button my toddler’s coat, I thought my finger was broken, so I went to the emergency room (ER), where it was X-rayed.

The doctors assured me everything was fine. They didn’t suggest seeing a rheumatologist or an orthopedist. Instead, they gave me a splint to rest my finger and to heal. I trusted the doctors and assumed my finger would get better.

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Ignoring my better judgment

It didn’t get better.

My finger became more sensitive, and I was aware of it while dressing, driving, doing laundry, cooking, and doing basic daily tasks.

It was excruciating to tie my child’s shoes.

When the pain in my index finger became intolerable, I had to use my middle finger to hold utensils, brush my hair, or do anything.

One day, my mom watched me scream in pain when I accidentally bumped my finger against the counter. She was really concerned and mentioned the possibility of silicone knuckle replacements.

I was desperate for relief and wanted to learn more.

Time went on, and I allowed the damage in my finger to get worse without knowing it was arthritis.

Deep down, I knew what the ER doctor had told me was wrong. Everything wasn’t OK. I felt silly for relying on his words and not advocating for myself earlier.

But arthritis is an insidious disease, creeping up on you when you least expect it. It comes and goes, and the swelling is slow to grow. It makes you feel confused, wondering whether you have a bruise or possibly jammed your finger.

Now, my finger felt useless, and it took a lot for me to visit the doctors again.

Visiting my rheumatologist

I was fortunate that I already had a rheumatologist for spondyloarthropathy in my sacroiliac joints, which link the pelvis and lower spine, but I was not yet diagnosed with rheumatoid arthritis (RA).

I saw my rheumatologist often because I receive Remicade infusions every 6 weeks to reduce inflammation in my back. But the Remicade, a biologic, did nothing for my painful fingers.

In the past, I had received cortisone shots in my swollen fingers, but they didn’t help.

I again showed the doctor my fingers. At this point, my rheumatologist diagnosed me with RA. However, she said the medications I was currently on should reduce the inflammation. They clearly hadn’t, and I wasn’t about to give up this time.

So, I requested a referral to an orthopedic surgeon to consider the option of a knuckle replacement. The rheumatologist told me that it wouldn’t help since the RA would continue to come back.

I argued that the arthritis would never come back in that spot if I had a fake knuckle. She agreed, but she still didn’t recommend orthopedic surgery for arthritic knuckles. Instead, she felt that the medications I was receiving should be treatment enough.

Taking myself to see an orthopedist

I wanted to visit an orthopedist to learn more about knuckle surgery and whether I was a good candidate for it.

I saw an orthopedic surgeon who X-rayed my finger and told me I barely had any middle knuckle left and my joints were bone on bone.

Not only was I a great candidate for a silicone knuckle, but I was a candidate months ago before the total destruction began.

I was astounded to see my X-rays. The orthopedist wondered why I didn’t see him earlier. I had no idea that seeing an orthopedist was an option.

My surgery was scheduled.

For me, there was no other choice, as the knuckle had fully deteriorated, and my finger bones were scraping against each other. I knew it would only get worse as time marched on.

Medicare covered the surgery, and since there was an incredible amount of damage coupled with excruciating pain, I scheduled surgery as quickly as possible.

What’s the process for knuckle replacement?

Replacement of the middle knuckle is also referred to as a proximal interphalangeal (PIP) joint arthroplasty. The PIP joint is in the middle of your finger and allows it to bend.

You can learn about other types of finger joint replacements here.

There are several different types of replacement materials, including metal and ceramic, but silicone is the most common.

The surgery is usually done under general anesthesia and takes about an hour.

Different approaches can be taken, but for my surgery, an incision was made vertically along the middle knuckle. The diseased joint and inflamed tissues were removed, and the joint was replaced with shaped ends to fit into the shafts of the finger bones.

The surgeon also repaired, strengthened, and rebalanced the ligaments and tendons surrounding the joint, which caused the initial damage.

Recovery from my surgery

Recovery from my silicone knuckle replacement was a grueling process. I had to learn to bend my finger again.

Both the doctor and occupational therapist said movement must begin as soon as possible so that the finger doesn’t become stiff and stuck in one position.

So, I started occupational therapy before the stitches were even healed. I continued this twice a week for 6 weeks to learn how to bend my finger with its new knuckle.

Am I pleased with my silicone knuckles?

Since this initial surgery, I’ve had three other knuckles replaced. I am thrilled with all of them.

I decided to do two of them at the same time, as I wanted to avoid multiple surgeries. The recovery was definitely more difficult in this instance.

There is no more pain, as the knuckles are fake. Sometimes, there’s minor stiffness, but nothing like when the joints were diseased. Another benefit is my affected fingers are no longer swollen, and I can use them to do daily tasks.

I can wear my rings again. I can tie my child’s shoes. I can button their coats. I can’t tell you how happy I am.

Advocate for yourself

The medical field, in general, can be a scary place. Just because a medical professional tells you something about your body doesn’t mean they’re correct.

If you still feel pain or you don’t feel that the advice or diagnosis you were given is correct, please continue seeking answers.

I made the mistake of letting my arthritic finger progress until I had barely any knuckle because an ER doctor told me I was fine. He knew nothing about arthritis and was only searching for a broken knuckle. He didn’t give me any further advice about rheumatology or orthopedic physicians.

If this has ever happened to you, please continue searching for help. The right doctor is out there.

The takeaway

The option to have silicone knuckles instead of living with painful arthritic knuckles isn’t very well-known. I only knew about it because of my mom.

I’m thrilled with my decision to have some of my middle knuckles replaced. My fingers are once again functional.

After having my initial concerns and pain dismissed, I’d recommend speaking with doctors outside of your regular physician. Orthopedics specialize in bones and have a different view than rheumatologists. I learned a lot about my body from looking at it through an orthopedic lens.

It’s so important to advocate for yourself. Listen to your body and take care of yourself — you matter.