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 the 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.
He weighs more conservative options -- a cortisone injection to eliminate pain and fusing the joint. But relief from injections often does not last, and a fused joint is stuck in one position. He didn't think a fusion would help Stetson in this joint.
"A golfer can't function like that," he says. "They need to be able to wrap their fingers around a club. A non-compliant finger won't let them do that."
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.
A downside to the implant: It has a shelf life of about seven to 10 years, depending on bone quality and the forces and load on it.
"We chose arthroplasty for Mrs. Stetson, knowing it would not last forever," Wolfe says. "It might break down. For someone in their 80s or 90s, though, they probably don't think about that a whole lot."
Because PIP implants can loosen over time, surgeons consider them a last resort, says physician Leon Benson, spokesman for the American Academy of Orthopedic Surgeons. "They must be used with discretion, based on the patient's lifestyle and expectations."
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.
Because she regained her grip strength, Stetson was able to join her daughter and two nieces on a bike tour of Vietnam last summer.
"When the bike instructors saw me on a decline, they told me I was going much too quickly," she says. "I said I was merely trying to catch up. They thought I was being competitive. They had me figured out."
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