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.
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.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.