Artificial metacarpophalangeal and interphalangeal joint replacement for end-stage arthritis

NICE interventional procedure guidance [IPG110] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on artificial metacarpophalangeal and interphalangeal joint replacement for end-stage arthritis.

  • Description

    This procedure is used to treat osteoarthritis of the hand. Common sites of osteoarthritis which may be suitable for artificial implants include the wrist, the carpometacarpal joint of the thumb (also called trapeziometacarpal joint) and the metacarpophalangeal and interphalangeal joints of the fingers and thumb. Osteoarthritis of hand joints is a common condition which deteriorates over time, although severity of symptoms, rate of deterioration and functional effects are variable.

    The surgeon removes the diseased joints in an open operation and replaces them with an implant, typically made of a silicone based material. A range of implants from different manufacturers are available for different joints.

    Other treatments for osteoarthritis of the hand include conservative management with anti-inflammatory and analgesic medication; complete joint excision (also called excision arthroplasty); fusion of the joint (arthrodesis); and native graft arthroplasties, in which the patient's own tissue (typically tendons) is interposed in the space left after joint excision.

    There are no routinely available data on the number of procedures carried out in the UK each year on hand joints.

  • OPCS4.6 Code(s)

    One of the following OPCS-4 categories is selected:

    W43.- Total prosthetic replacement of other joint using cement

    W44.- Total prosthetic replacement of other joint not using cement

    W45.- Other total prosthetic replacement of other joint


    Site code from category Z83.- Joint of finger depending on the joint replaced.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.

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